多模式镇痛在胃肠道术后患者中的应用

Application of multimodal analgesia in patients after gastrointestinal surgery

随着外科技术飞速发展,接受胃肠道大手术的患者死亡率较前明显降低,但术后疼痛是阻碍患者加速康复的重要原因;胃肠道术后疼痛多为中重度,其来源于主要在于切口疼痛、内脏疼痛、炎性疼痛,疼痛在传递过程中复杂且易受其他因素影响,充分镇痛是十分必要且困难的;而单一镇痛方法和药物不能达到最佳的镇痛效果,且其不良反应、并发症多;而多模式镇痛(MMA)是近年来国内外所推荐的镇痛模式,相比于传统的单一镇痛药物的使用,多模式镇痛模式能起到最佳的镇痛效果、阿片类药物不良反应明显减少,本文综述了胃肠道术后患者在多模式镇痛理念下镇痛方案的常见组合及相关镇痛药物和镇痛方式的优缺点。

With the rapid development of surgical technology,the mortality rate of patients undergoing major gastrointestinal surgery is significantly lower than before,but postoperative pain is an important reason to prevent patients from accelerating recovery.Most of the postoperative pain in gastrointestinal tract is moderate and severe,which mainly comes from incision pain,visceral pain and inflammatory pain.Pain is complex and easily affected by other factors in the process of transmission,adequate analgesia is necessary and difficult.However,single analgesic drugs and methods can not achieve the best analgesic effect,and there are many adverse reactions and complications.Multimodal analgesia(MMA)is an analgesic mode recommended at home and abroad in recent years,compared with the use of traditional single analgesics,multimodal analgesia can have the best analgesic effect and significantly reduce the adverse reactions of opioids.This article reviews the concept of multimodal analgesia,common combinations of analgesic schemes,and the advantages and disadvantages of related analgesics and analgesic methods for patients after gastrointestinal surgery.