不同剂量普瑞巴林在胸腔镜下食管癌根治术后疼痛中的应用

Dose ranging effects of Pregabalin on postoperative pain undergoing radical resection of esophageal cancer under thoracoscopy

目的探讨不同剂量普瑞巴林在胸腔镜下食管癌根治术后疼痛中的应用效果。方法选取2019年1月—2020年1月于南京医科大学第一附属医院择期行胸腔镜下食管癌根治术的120例患者作为研究对象,采用随机数字表法将其分为P1组(采用低剂量普瑞巴林,30例)、P2组(采用中剂量普瑞巴林,30例)、P3组(采用高剂量普瑞巴林,30例)和C组(不采用普瑞巴林镇痛,30例)。P1组患者手术前1 d晚8点、术前1 h及术后6 h分别予75 mg普瑞巴林口服;P2组患者手术前1 d晚8点、术前1 h及术后6 h分别予150 mg普瑞巴林口服;P3组患者手术前1 d晚8点、术前1 h及术后6 h分别予300 mg普瑞巴林口服;C组患者不给予口服镇痛药物。比较四组患者清醒拔管出恢复室(T0)、术后2 h(T_(1))、术后6 h(T_(2))、术后12 h(T_(3))、术后24 h(T_(4))、术后48 h(T_(5))的静息、咳嗽状态下视觉模拟评分(VAS)、麻醉诱导前镇静(Ramsay)评分、术后2 d匹兹堡睡眠质量指数量表(PSQI)评分、术后48 h静脉自控镇痛泵(PCIA)使用剂量及头晕、恶心呕吐、视觉障碍、瘙痒、周围水肿等不良反应发生情况。结果P1、P2、P3组患者T0、T_(1)、T_(2)、T_(3)、T_(4)、T_(5)的静息和咳嗽状态下VAS评分均低于C组,差异有统计学意义(P<0.05)。P1、P2、P3组患者麻醉诱导前Ramsay评分高于C组,差异有统计学意义(P<0.05)。P1、P2、P3组术后2 d PSQI评分低于C组,差异有统计学意义(P<0.05)。P1、P2、P3组术后48 h PCIA使用剂量低于C组,P2、P3组低于P1组,P3组低于P2组,差异有统计学意义(P<0.05)。P3组头晕发生率高于P1、P2、C组,差异有统计学意义(P<0.05)。结论普瑞巴林能够有效缓解胸腔镜下食管癌根治术后疼痛,口服150 mg普瑞巴林是更加安全、有效的剂量。

Objective To investigate the effect of different doses of Pregabalin on postoperative pain undergoing radical resection of esophageal cancer under thoracoscopy.Methods A total of 120 patients underwent radical resection of esophageal cancer under thoracoscopy in the First Affiliated Hospital of Nanjing Medical University from January 2019 to January 2020 were selected as the research objects.The patients were divided into group P1(low-dose pregabalin,30 cases),group P2(medium-dose pregabalin,30 cases),group P3(high-dose pregabalin,30 cases)and group C(no pregabalin,30 cases)by random number table method.Patients in group P1 received orally Pregabalin concentration of 75 mg respectively,at 8 pm a night before surgery,1 h before surgery and 6 h after surgery.Patients in group P2 received orally Pregabalin concentration of 150 mg respectively,at 8 pm a night before surgery,1 h before surgery and 6 h after surgery.Patients in group P3 received orally Pregabalin concentrations of 300 mg respectively,at 8 pm a night before surgery,1 h before surgery and 6 h after surgery,whereas group C received no oral analgesic drugs at the same scheme.The visual analogue score(VAS)in resting and cough state,Ramsay score in anaestheti-induced sedation(Ramsay),and 2 h after operation in the recovery room(T0),2 h after operation(T_(1)),6 h after operation(T_(2)),12 h after operation(T_(3)),24 h after operation(T_(4))and 48 h after operation(T_(5)),Pittsburgh Sleep Quality Index(PSQI)score,48 h postoperative intravenous controlled analgesia pump(PCIA)dosage,dizziness,nausea and vomiting,visual impairment,pruritus,peripheral edema and other adverse reactions were compared.Results VAS scores in T0,T_(1),T_(2),T_(3),T_(4) and T_(5) in groups P1,P2 and P3 were lower than those in group C in resting and coughing state,and the differences were statistically significant(P<0.05).The Ramsay score before induction of group P1,P2,P3 were lower than those of group C,and the differences were statistically significant(P<0.05).The PSQI score of group P1,P2,P3 were lower than those of group C,and the differences were statistically significant(P<0.05).The dosage of analgesics in PCIA of group P1,P2,P3 were lower than those of group C,the dosage of Group P2,P3 were lower than those of Group P1,the dosage of group P3 was lower than that of group P2,and the differences were statistically significant(P<0.05).The incidence of dizziness of group P3 was lower than that of group P1,P2,C,and the differences were statistically significant(P<0.05).Conclusion The application of Pregabalin in the radical surgery of thoracoscopic esophageal cancer can alleviate the postoperative pain,and oral administration of 150 mg Pregabalin is an effective and safe method for postoperative pain management after radical resection of esophageal cancer under thoracoscopy.