疼痛管理在减重代谢手术中的应用

Clinical application of ERAS multimodal pain management strategy in metabolic and bariatric surgery

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)疼痛管理模式对减重代谢手术术后疼痛管理的影响。方法选取2017年1月至2018年10月上海市浦东医院减重外科收治的50例接受腹腔镜袖状胃切除术的病人为研究对象,50例病人随机数字表法分为两组,对照组(25例)给予术后常规疼痛护理,观察组(25例)给予ERAS理念下的疼痛管理模式,比较两组病人之间差异。结果ERAS疼痛管理的病人手术当日、术后1 d、术后2 d与出院日的综合疼痛评分均低于对照组,差异均具有统计学意义(均P<0.05);病人首次下床时间及住院时间也均显著短于对照组(P<0.05);此外,休斯顿疼痛情况评分也显著低于对照组,差异具有统计学意义(P<0.05)。结论ERAS理念下疼痛管理能有效减缓病人疼痛程度,缩短病人早期下床活动时间,减少住院时间,提高病人满意度。

Objective To investigate the influences of enhanced recovery after surgery(ERAS)pain management protocol in pain control after metabolic and bariatric surgery. Methods Fifty obese patients who underwent laparoscopic sleeve gastrectomy in our bariatric surgery center between January 2017 and October 2018 were included in this study. The patients were randomly divided into two groups:the control group was given the traditional pain management protocol,and in the interventional group,a multimodal pain management protocol based upon ERAS was administered. The difference in pain-related clinical outcome between two groups were compared. Results Patients with ERAS pain management protocol had significantly lower composite pain score than the control group patients on the day of surgery,1-day and 2-day after surgery,as well as the day of discharge( P <0.05). The time to mobilization and length of stay in hospital were also reduced in the ERAS group( P <0.05). In addition,Houston Pain Survey Questionnaire was adopted to evaluate the degree of pain after surgery. The score in ERAS group was also significantly lower( P < 0.05). Conclusion ERAS pain management can effectively relieve pain, shorten the time for patients to mobilization,reduce the length of hospital stay and improve patient satisfaction.