新辅助化疗对胃癌患者术后早期疼痛及围术期恢复的影响

Effects of neoadjuvant chemotherapy on early postoperative pain and perioperative recovery in patients with gastric cancer

目的:探讨新辅助化疗对进展期胃癌患者术后早期疼痛及围术期恢复的影响。方法:采用回顾性分析方法,收集2017年1月至2018年12月进展期胃癌且行胃癌根治术患者74例的临床资料,患者年龄≥18岁,ASAⅡ~Ⅲ级。根据是否接受新辅助化疗将患者分为新辅助化疗组(N组,35例)和对照组(C组,39例)。N组患者接受FOLFOX方案化疗,化疗结束后2周行胃癌根治术,两组患者麻醉方案相同。记录两组患者一般情况、气管导管拔出时间、麻醉后恢复室(PACU)停留时间、术后几个时间点(6、24、48、72 h)疼痛数字评价量表(NRS)评分、补救性镇痛药使用例数、术后住院时间及不良反应。结果:与C组相比,N组患者术后24、48、72 h NRS评分均增高,气管导管拔出时间延长,PACU停留时间延长,术后补救性镇痛药使用例数增多,术后住院时间延长(均P<0.05);两组患者术后首次排便及不良反应发生率比较差异无统计学意义(P>0.05)。结论:新辅助化疗可增加胃癌根治术患者术后早期的疼痛强度和镇痛药的使用,延长气管导管拔出时间、PACU停留时间及术后住院时间,但不增加相关不良反应。

Objective:To investigate the effect of neoadjuvant chemotherapy on early postoperative pain and perioperative recovery in patients with advanced gastric cancer.Methods:A retrospective analysis method was used to collect clinical data of patients with advanced gastric cancer who underwent radical gastric cancer surgery between January 2017 and December 2018.A total of 74 patients aged 18 years or more with ASA gradeⅡ-Ⅲwere enrolled.According to whether the patients received neoadjuvant chemotherapy,they were divided into the neoadjuvant chemotherapy group(group N,n=35)and the control group(group C,n=39).Patients in group N received FOLFOX chemotherapy,and radical gastric cancer surgery was performed 2 weeks after chemotherapy.The two groups of patients received identical anesthesia plans.We recorded the general conditions of the patients,time of tracheal extubation,time of stay in the postanaesthesia care unit(PACU),6,24,48,72 h postoperative pain numerical rating scale,number of cases of rescue analgesics,length of postoperative hospital stay and adverse reactions.Results:Compared with patients in group C,patients in group N had significantly higher NRS at 24 h,48 h,and 72 h after surgery,longer time of tracheal extubation,longer PACU stay time,larger numbers of postoperative rescue analgesics,and longer postoperative hospital stays(all P<0.05).There was no significant difference in the time of initial postoperative defecation and the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Neoadjuvant chemotherapy can increase the pain intensity and the use of analgesics in the early postoperative period of radical gastric cancer patients,prolong the tracheal tube extraction time,PACU stay time and the postoperative hospital stay,but does not increase related adverse reactions.