手术患者术后慢性疼痛经多模式镇痛对睡眠质量的影响及机制分析

Impacts and mechanism analysis of multimodal analgesia on sleep quality in patients with chronic postoperative pain

目的 探讨手术患者术后慢性疼痛经多模式镇痛对睡眠质量的影响及机制分析。方法 选取2020年2月至2022年2月甘肃省中医院收治的150例接受外科手术治疗的患者作为研究对象,使用随机数表法将患者分为观察组与对照组,每组各75例。对照组患者接受单一镇痛干预,实施硬膜外自控镇痛,观察组患者接受多模式镇痛干预,实施静脉内患者自控镇痛(PCIA)联合超声引导下腹横纹肌平面阻滞(TAP)。收集两组患者术后发生急性与慢性疼痛情况,并对睡眠质量和炎性因子水平进行比较分析。结果 术后6 h两组患者视觉模拟评分法(VAS)评分差异无统计学意义(P>0.05),术后24、48 h,观察组患者VAS评分均低于对照组,差异有统计学意义(P<0.05)。术后3个月,观察组患者慢性疼痛VAS评分以及神经性疼痛(ID Pain)评分均低于对照组,差异有统计学意义(P<0.05)。观察组患者匹兹堡睡眠质量指数(PSQI)评分低于对照组,良好睡眠率高于对照组患者,差异有统计学意义(P<0.05),观察组患者血清白介素-6(IL-6)、白介素-8(IL-8)以及肿瘤坏死因子α(TNF-α)水平均显著低于对照组,差异有统计学意义(P<0.05)。结论PCIA联合TAP这种多模式镇痛措施,能够有效缓解手术患者急性和慢性术后疼痛,改善患者睡眠质量,利于术后康复,这可能与该模式能够降低全身炎性反应有关。该多模式镇痛措施具有较为显著的临床意义,值得推广应用。

Objective To investigate the impacts and mechanism of multimodal analgesia on sleep quality in patients with chronic postoperative pain. Methods A total of 150 patients who received surgical treatment in Gansu Provincial Hospital of Traditional Chinese Medicine from February 2020 to February 2022 were selected as the study subjects. They were were divided into observation group and control group by random number table method, with 75 cases in each group. The patients in the control group received single analgesia intervention and patient-controlled epidural analgesia(PCEA) was implemented, while the patients in the observation group received multimodal analgesia intervention and patient-controlled intravenous analgesia(PCIA) was implemented combined with ultrasound-guided transversus abdominis plane(TAP) block. The acute and chronic pain data of patients in the two groups were collected, and their sleep quality and inflammatory factor levels were compared and analyzed. Results There was no significant difference in visual analogue scale(VAS) score between the two groups at 6 h after operation(P > 0.05). The VAS score of patients in the observation group was lower than that in the control group at 24 h and 48 h after operation, with statistically significant difference(P< 0.05). And the chronic pain VAS score and ID pain score of patients in the observation group were lower than those in the control group at 3 months after operation, with statistically significant differences(P< 0.05).The Pittsburgh sleep quality index(PSQI) score of patients in the observation group was lower than that in the control group, and the good sleep rate in the observation group was higher than that in the control group, with statistically significant differences(P< 0.05). The levels of interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor α(TNF-α) in serum in the observation group were lower than those in the control group, with statistically significant differences(P< 0.05). Conclusion Intravenous PCA combined with ultrasound-guided transversus abdominis plane block, a multimodal analgesia measure, can effectively relieve the acute and chronic postoperative pain of surgical patients, improve the sleep quality of patients, and facilitate postoperative recovery,which may be related to the fact that the mode can reduce systemic inflammatory reaction. This multimodal analgesia measure has significant clinical significance and is worthy of promotion and application.