不同麻醉与多模式镇痛方案在开腹胰十二指肠切除术加速康复外科中的应用

Application of Different Perioperative Anesthesia Plans and Multimodal Analgesia in Enhanced Recovery after Surgery for Open Pancreaticoduodenectomy

目的评估不同麻醉与多模式镇痛在开腹胰十二指肠切除术加速康复外科(enhanced recovery after surgery,ERAS)策略中的安全性与有效性。方法采用回顾性队列研究,收集2016年3月至2018年4月北京协和医院39例开腹胰十二指肠切除术患者的临床资料,其中19例采用ERAS治疗方案(ERAS组),20例采用常规治疗方案(对照组),比较两组患者术中血流动力学相关指标、外周组织灌注情况及麻醉相关术后早期恢复指标、住院时间、ICU停留时间、住院费用的差异。结果 ERAS组患者术中阿片药用量、出室前血乳酸浓度显著低于对照组(P均<0. 05),术后第一天外周血白细胞数量及中性粒细胞数量、血糖、术后早期阿片药用量、疼痛及恶心评分、镇痛满意度、拔除导尿管和胃管时间、术后首次下床活动时间、首次排气时间、住院费用各项指标均显著优于对照组(P均<0. 05);两组患者手术时间、术中血流动力学相关指标、出血量无显著差异(P均>0. 05)。结论应用不同ERAS麻醉与多模式镇痛策略可有效减轻开腹胰十二指肠切除术患者的手术应激、减少阿片药用量、促进术后早期恢复、缩短住院时间、降低住院费用。

Objective This study aimed to evaluate the satety and eftectiveness of different anesthetic approaches and multimodal analgesia in enhanced recovery after surgery （ERAS） when applied to open pancreati- coduodenectomy patients. Methods In this retrospective cohort study, we consecutively collected clinical data from 39 patients undergoing open pancreaticoduodenectomy in Peking Union Medical College Hospital from March 2016 to April 2018, among which 19 patients received ERAS strategy （ERAS group） and 20 traditional strategy （control group）, and compared the ditterences in intra-operative hemodynamic changes, post-operative rehabilitation, length of stay, and costs between the ERAS group and the control group. Results The intraoperative opioid consumption and postoperative lactic acid in the ERAS group were lower than those in the control group （ both P〈0.05）. White blood cell and neutrophil counts on the postoperative day 1, blood glucose, pain score, postoperative nausea and vomiting, postoperative analgesia satisfaction, time to remove the transurethral catheter and nasogastric tube, time to exhaust and ambulation, and medical costs were all improved compared to the control group （all P 〈 0.05 ）. Whereas operating duration, intraoperative hemodynamic changes, and intraoperative bleeding were comparable between the two groups （all P 〉 0.05 ）. Conclusions Different perioperative anesthesia plans and multimodal analgesia in ERAS strategy are safe when applied to open pancreaticoduodenecto- my patients. It could effectively mitigate operative stress, decrease opioid exposure, expedite postoperative reha- bilitation, shorten the length of hospital stay, and decrease medical cost.