规范化多模式镇痛在肝切除术后加速恢复中的临床应用

发布时间：2018-06-20 07:05

本文选题：肝切除术 + 手术后并发症/预防和控制　；参考：《中国普通外科杂志》2017年07期

【摘要】：目的:评价规范化多模式镇痛治疗在肝切除围手术期的临床效果。方法:采用随机对照的方法,选取2014年1月—2016年6月行开腹肝部分切除的患者60例,分为多模式镇痛组和静脉镇痛组各30例。多模式镇痛组采用胸段硬膜外布比卡因加吗啡持续泵入,切口注射罗哌卡因,术后使用针剂非甾体类抗炎药丙帕他莫,口服双氯芬酸钠序贯镇痛;静脉镇痛组采用舒芬太尼加羟考酮持续泵入。术后测定48 h内视觉模拟评分(VAS),记录术后排气时间、口服半流质饮食时间、术后住院时间、恶心呕吐、感染、出血等不良反应及并发症。结果:多模式镇痛组疼痛评分在术后12 h时低于静脉镇痛组[(4.2±1.2)vs.(5.1±1.6)],总体镇痛效果好于静脉镇痛组;与静脉镇痛组相比,多模式镇痛组术后排气时间[(35.7±8.9)h vs.(48.6±10.8)h],下床时间[(30.6±9.8)h vs.(36.0±10.4)h],饮食恢复时间[(3.7±0.6)d vs.(5.9±0.9)d]均优于静脉镇痛组(均P0.05),且围手术期镇痛费用较静脉镇痛组更低[(520±35)元vs.(660±38)元,P0.01]。两组患者在恶心呕吐、尿潴留、切口及肺部感染、消化道出血、深静脉血栓发生率方面均无统计学差异(P0.05)。结论:多模式镇痛治疗能够更有效的控制肝切除术后疼痛,加快肠道功能恢复,减轻不良反应,促进快速康复。
[Abstract]:Objective: to evaluate the clinical effect of standardized multi-mode analgesia in perioperative period of hepatectomy. Methods: 60 patients undergoing partial hepatectomy from January 2014 to June 2016 were randomly divided into multi-mode analgesia group (n = 30) and intravenous analgesia group (n = 30). In the multi-mode analgesia group, epidural bupivacaine and morphine were continuously pumped in the thoracic segment, ropivacaine was injected into the incision, the injection of non-steroidal anti-inflammatory drug Propatamol was used after operation, and diclofenac sodium was taken orally for sequential analgesia. The intravenous analgesia group was continuously pumped with sufentanil and hydroxycodone. Visual analogue score (VAS) was measured within 48 hours after operation. The time of exhaust, oral half-fluid diet, postoperative hospitalization, nausea and vomiting, infection, bleeding and other adverse reactions and complications were recorded. Results: the pain score of multi-mode analgesia group was lower than that of intravenous analgesia group at 12 hours after operation [4.2 卤1.2)vs.(5.1 卤1.6], and the overall analgesic effect was better than that of intravenous analgesia group, and compared with intravenous analgesia group. The postoperative venting time [35.7 卤8.9 vs.(48.6 卤10.8 h], the time of getting out of bed [30.6 卤9.8 h vs.(36.0 卤10.4 h] and the recovery time of diet [3.7 卤0.6 d vs.(5.9 卤0.9d] in the multi-mode analgesia group were significantly higher than those in the intravenous analgesia group (P 0.05), and the cost of analgesia in the perioperative period was lower than that in the intravenous analgesia group [520 卤35 yuan, vs.(660 卤38, P 0.01]. There was no significant difference in nausea and vomiting, urinary retention, incision and lung infection, gastrointestinal hemorrhage and deep venous thrombosis between the two groups (P 0.05). Conclusion: multimode analgesia therapy can effectively control the pain after hepatectomy, accelerate the recovery of intestinal function, alleviate adverse reactions and promote rapid recovery.
【作者单位】：江苏省常州市第三人民医院肝胆外科;
【基金】：江苏省常州市科技计划基金资助项目(CS20102014)
【分类号】：R735.7

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