多模式镇痛在开腹卵巢癌术后加速康复中的应用

The research on the application of multimodal analgesia of enhanced recovery for ovarian cancer patients undergoing laparotomy

目的研究和分析加速康复外科(ERAS)理念下多模式镇痛在开腹卵巢癌围手术期的应用效果。方法选取51例接受开腹手术的卵巢癌患者作为研究对象,随机分为实验组(多模式镇痛组,26例)和对照组(25例)。实验组:手术麻醉诱导前给予地塞米松10mg和帕瑞昔布钠40mg静脉注射,于切皮前或关腹前在腹壁切口周围浸润注射0.5%罗哌卡因10ml,术后常规应用静脉自控(PCIA)泵镇痛至术后48h;对照组:仅应用PCIA镇痛,药物配比、浓度及应用时间均同实验组。观察和记录两组患者术后6h、12h、24h疼痛视觉模拟(VAS)评分、止痛药补充率及恶心呕吐(PONV)发生率,术后恢复指标(首次排气、排便时间、术后住院时间)变化,术前及术后第1天应激指标(白细胞、中性粒细胞、白蛋白)变化,并发症(切口感染、血栓、肺部感染、肠梗阻)发生率。结果多模式镇痛组术后6h、12h、24h疼痛评分为(3.34±0.97)、(2.69±0.83)、(1.76±0.58)分,对照组为(4.08±1.28)、(3.28±0.93)、(2.16±0.62)分,两组相比,多模式镇痛组各时间点疼痛评分更低,差异有统计学意义(t=2.297,t=2.365,t=2.303,P<0.05)。实验组2例患者术后补充止痛药,对照组9例患者补充止痛药,两组相比差异有统计学意义(χ^(2)=4.480,P<0.05)。术后PONV发生率无明显统计学意义(P>0.05)。术后第1天血白细胞、中性粒细胞、白蛋白数值差异均有统计学意义(P<0.05),且实验组优于对照组。实验组在术后排气及排便时间、住院时间均低于对照组(P<0.05)。实验组2例患者术后出现切口感染,对照组1例出现切口感染,两组相比无统计学意义(P>0.05),两组均无血栓、肺部感染、肠梗阻并发症的发生。结论多模式镇痛可以减轻开腹卵巢癌患者术后的疼痛,加速患者的术后康复,值得临床应用及推广。

Objective To study and analyze the effect of multimodal analgesia under the concept of enhanced recovery after surgery in the perioperative period of open ovarian cancer. Methods Fifty-one patients with ovarian cancer who underwent open surgery were selected as the observation and analysis objects of this trial, with 26 cases in the experimental group(multimodal analgesia group) and 25 cases in the control group.Experimental group: 10 mg of dexamethasone and 40 mg of parecoxib were given intravenously before induction of anesthesia, and 10 ml of 0.5% ropivacaine was infiltrated around the abdominal incision before skin incision or abdominal closure.Routine intravenous self-control after surgery(PCIA) pump analgesia should be used up to 48 hours after surgery;control group: only PCIA analgesia, with drug ratio, concentration and application timing of drugs being the same as the experimental group.Observe and record the pain visual simulation(VAS) scores, analgesic replenishment rate and nausea and vomiting(PONV) rate of the two groups of patients after 6 h, 12 h, and 24 h after operation, and postoperative recovery indicators(first exhaust, defecation time, postoperative hospital stay) Changes, changes in stress indicators(white blood cells, neutrophils, albumin) on the first day as well as the incidence of complications(thrombosis, incision infection, intestinal obstruction).Results The pain scores of the multimodal analgesia group were(3.34±0.97),(2.69±0.83),(1.76±0.58) at 6 h, 12 h, and 24 h after the operation, and the control group were(4.08±1.28),(3.28±0.93),(2.16±0.62) points.Compared with the two groups, the multimodal analgesia group had lower pain scores at each time point, and the difference was statistically significant(t=2.297,t=2.365,t=2.303,P<0.05).Two patients in the experimental group were supplemented with analgesics after surgery, and 9 patients in the control group were supplemented with analgesics.The difference between the two groups was statistically significant(χ^(2)=4.480,P<0.05).The incidence of postoperative PONV was not statistically significant(P>0.05).The differences in the values of blood white blood cells, neutrophils and albumin on the first day after surgery were statistically significant(P<0.05),and the experimental group was better than the control group.The time of exhaust, defecation and hospital stay in the experimental group were lower than those in the control group(P<0.05).Two patients in the experimental group had wound infection after surgery, and one in the control group had wound infection.There was no significant difference between the two groups(P>0.05).There was no complication of thrombus, pulmonary infection and intestinal obstruction in both groups.Conclusion Multimodal analgesia can reduce the postoperative pain of patients with ovarian cancer after laparotomy, and accelerate the postoperative recovery of patients.It is worthy of clinical application and promotion.