超前镇痛用于老年腹腔镜肝切除术患者的价值研究

The value of preemptive analgesia in older adult patients undergoing laparoscopic hepatectomy

目的探讨超前镇痛用于老年腹腔镜肝切除术患者的效果及价值。方法选取2019年7月至2020年4月在温州医科大学附属第二医院接受腹腔镜肝切除术治疗的老年肝癌患者150例,采用随机数字表法分为对照组75例、观察组75例。对照组给予帕瑞昔布钠术后镇痛,观察组给予帕瑞昔布钠超前镇痛。观察两组术后8 h、12 h、24 h数字疼痛评分(NRS)及术后恢复情况、住院时间及费用。结果两组手术时间、术后24 h舒芬太尼用量、舒芬太尼镇痛泵自控镇痛(PCIA)总次数及有效次数差异均无统计学意义(均P>0.05)。观察组术后8 h、12 h、24 h的NRS分别为(4.38±1.24)分、(3.41±0.19)分、(2.90±0.17)分,均低于对照组的(5.24±1.01)分、(4.65±1.24)分、(3.32±1.00)分,差异均有统计学意义(t=4.66、8.56、3.59,均P<0.001);观察组术后第1天下床活动次数[(2.62±1.24)次]多于对照组[(1.06±0.12)次],下床活动总时间[(1.36±0.20)h]长于对照组[(0.36±0.09)h],首次肛门排气时间[(13.50±1.27)h]短于对照组[(20.10±2.16)h],差异均有统计学意义(t=-10.84、-39.49、22.81,均P<0.001);观察组术后住院天数[(8.90±1.34)d]短于对照组[(11.15±1.29)d],住院费用[(5.58±0.21)万元]少于对照组[(5.94±0.62)万元],患者护理满意度评分[(88.98±5.64)分]高于对照组[(72.16±3.26)分],差异均有统计学意义(t=10.48、4.76、-22.36,均P<0.001)。结论超前镇痛可有效提高老年腹腔镜肝切除术患者的镇痛效果,有助于加快患者术后康复速度,缩短其住院时间,明显减少患者的住院费用。

Objective To investigate the efficacy and value of preemptive analgesia in older adult patients undergoing laparoscopic hepatectomy.Methods A total of 150 older adult patients with liver cancer,who underwent laparoscopic hepatectomy at The 2nd Affiliated Hospital of Wenzhou Medical University between July 2019 and April 2020,were randomly assigned to two groups:a control group(n=75)and an observation group(n=75)using the random number table method.The control group received postoperative analgesia with parecoxib sodium,while the observation group received preemptive analgesia with parecoxib sodium.A comparative analysis was conducted between the control and observation groups in terms of the Numerical Rating Scale(NRS)scores at 8,12,and 24 hours postoperatively,postoperative recovery,length of hospital stay,and overall cost.Results There were no statistically significant differences in operation time,dosage of Sufentanil 24 hours postoperatively,or the total and effective usage counts of patient-controlled intravenous analgesia with Sufentanil between the control and observation groups(both P>0.05).However,the NRS scores of the observation group were significantly lower than those of the control group at 8,12,and 24 hours postoperatively.Specifically,the NRS scores of the observation group were(4.38±1.24)points,(3.41±0.19)points,and(2.90±0.17)points,respectively,while those of the control group were(5.24±1.01)points,(4.65±1.24)points,and(3.32±1.00)points,respectively(t=4.66,8.56,3.59,all P<0.001).Patients in the observation group exhibited significantly more frequent off-bed activities[(2.62±1.24)times],a notably longer cumulative duration of off-bed activities[(1.36±0.20)hours],and a significantly shorter duration of first anal exhaust[(13.50±1.27)hours]compared with those in the control group[(1.06±0.12)times,(0.36±0.09)hours,(20.10±2.16)hours,t=-10.84,-39.49,22.81,all P<0.001].Furthermore,the observation group demonstrated a shorter postoperative hospital stay[(8.90±1.34)days],lower hospitalization costs[(55.8±2.1)thousand yuan],and higher patient satisfaction scores[(88.98±5.64)points]compared with the control group[(11.15±1.29)days,(59.4±6.2)thousand yuan,(72.16±3.26)points,t=10.48,4.76,-22.36,all P<0.001].Conclusion The implementation of preemptive analgesia intervention among older adult patients undergoing laparoscopic hepatectomy effectively enhances analgesic outcomes,accelerates postoperative recovery,reduces hospitalization duration,and markedly decreases hospitalization costs.