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42第4期
多模式镇痛在加速康复外科胃肠道肿瘤手术患者中的应用
Multimodal analgesia in Enhanced Recovery After Surgery(ERAS) Application in patients with gastrointestinal tumor surgery
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DOI:
作者:
蒋鹏 郭琪 曲雪菲 华佳 范昕 马鹏
Jiang Peng Guo Qi Qu Xuefei Hua Jia Fan Xin Ma Peng
作者单位:
江苏大学附属医院麻醉科 江苏大学医学院 江苏大学医学院 江苏大学附属医院麻醉科 江苏大学附属医院普外科 江苏大学附属医院麻醉科
Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China (Jiang Peng,Hua Jia, Ma Peng); Department of General Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China (Fan Xin),School of medicine, ,Jiangsu University, Zhenjiang, Jiangsu 212000,China (Guo Qi ,Qu Xuefei)
关键词:
多模式镇痛;加速康复外科;术后疼痛
multimodal analgesia; enhanced recovery after surgery; postoperative pain
摘要:
目的:探讨多模式镇痛在加速康复外科胃肠道肿瘤手术患者术后镇痛中的临床效果。方法:将我院胃肠外科2017年08月~2018年07月收住入院且需要手术的50例胃肠道肿瘤患者随机分为观察组和对照组,每组25例。观察组采用多模式镇痛:麻醉诱导前静脉注射帕瑞昔布钠40mg,关腹后行超声引导下双侧腹横肌平面阻滞,并予静脉自控镇痛泵(布托啡诺注射液3.5ug/kg/h+盐酸右美托咪啶0.08ug/kg/h);对照组采用常规的静脉自控镇痛泵(枸橼酸舒芬太尼注射液0.05ug/kg/h)。观察比较两组患者术后各时间点视觉模拟评分(VSA)、24小时白介素-6(IL-6)水平、首次下床活动时间、首次进流质时间、首次排气时间、住院天数、自控镇痛按压次数及不良反应。结果:观察组术后1h、6h、12h、24h、48h的VSA评分均显著低于对照组(P<0.05);术后24h观察组的 IL-6水平也显著低于对照组(P<0.05);患者术后首次下床活动时间、首次进流质时间、首次排气时间、住院天数观察组较对照组显著缩短(P<0.05);观察组的自控镇痛按压次数显著少于对照组(P<0.05);观察组不良反应发生率与对照组比较无统计学差异(P>0.05)。结论:胃肠肿瘤患者术后采用多模式镇痛,可以有效的缓解术后疼痛,加速患者康复,值得在临床推广应用。
Objective: To investigate the clinical effect of multimodal analgesia in Enhanced Recovery After Surgery(ERAS) in patients undergoing gastrointestinal surgery for postoperative analgesia. Methods: Fifty patients with gastrointestinal tumors admitted to our hospital from August 2017 to July 2018 were randomly divided into observation group and control group, 25 cases in each group. The observation group used multimodal analgesia: intravenous injection of parecoxib sodium 40 mg before anesthesia induction, ultrasound guided bilateral transversus abdominis plane block(TAP block)after surgery , and use intravenous controlled analgesia pump (Butorphanol Tartrate injection 3.5ug/kg/h + Dexmedetomidine Hydrochloride Injection 0.08ug/kg/h); the control group used a conventional intravenous self-controlled analgesia pump (sufentanil 0.05ug/kg/h). The visual analogue scale (VSA), 24-hour interleukin-6 (IL-6) level, first time to get out of bed, first time of eating liquid food, length of hospital stay, the press times of self-controlled pump and adverse reactions were observed and compared between the two groups. Results: The VSA scores of the observation group were significantly lower than those of the control group at 1h, 6h, 12h, 24h and 48h after operation (P<0.05=. The IL-6 level of the observation group was significantly lower than that of the control group at 24h after operation (P<0.05). The patient's first time to get out of bed, the first time of eating liquid food, and the number of days in hospital were significantly shorter than the control group (P<0.05). The number of controlled analgesia presses in the observation group was significantly lower than that of the control group (P<0.05); there was no statistical difference in the incidence of adverse reactions between the observation group and the control group (P>0.05). Conclusion: Multimodal analgesia in patients with gastrointestinal cancer can effectively relieve postoperative pain and accelerate the recovery of patients. It is worthy of clinical application.