加速康复外科模式下妇科良性疾病腹腔镜手术多模式镇痛与传统镇痛方案效果比较研究

A comparative study of multi-modal analgesic regimen versus traditional analgesic regimen in laparoscopic sur⁃gery for benign gynecological diseases under Enhanced Recovery After Surgery(ERAS)model.

目的比较加速康复外科(enhanced recovery after surgery,ERAS)模式下妇科良性疾病腹腔镜手术的多模式镇痛方案与传统镇痛方案的效果。方法收集在首都医科大学附属北京积水潭医院(2022年3月至2023年8月)和北京大学国际医院(2020年9月至2021年7月)诊治的291例妇科良性疾病患者。通过区组随机法,按手术类型将入组患者分为3组(附件组、子宫体组、子宫全切组),在每个区组内,患者被随机分配至研究组和对照组,比例为1∶1。研究组和对照组均采用相同的麻醉诱导方案和术中非甾体类抗炎药(NSAIDS)预防性镇痛方案,研究组在切皮前、术毕前均给予罗哌卡因切口局部浸润麻醉,术后给予NSAIDS类药物预防性镇痛;对照组未使用切口局部浸润麻醉,术后不给予常规镇痛(如患者要求,则给予自控镇痛泵镇痛)。比较两组患者术后2、6、24、48h疼痛视觉模拟评分(Visual Analogue Scale/Score,VAS)以及恶心、呕吐的发生率。结果研究组在术后6h相同状态下及术后24h静态下的VAS评分均显著低于对照组(P<0.05),且在术后2、6h相同状态及24h静态下的VAS评分显著低于对照组使用镇痛泵的患者(P<0.05);对照组使用镇痛泵者的恶心(35.2%vs.19.6%)和呕吐(27.8%vs.11.2%)发生率高于研究组(P>0.05)。结论在妇科良性疾病腹腔镜手术ERAS模式下的多模式镇痛方案在镇痛效果及舒适度方面优于传统镇痛方案,术后24h内是镇痛的最佳时间窗。

Objective To compare the effectiveness of multi-modal analgesic regimen versus traditional analgesic regli⁃men under the Enhanced Recovery After Surgery(ERAS)in laparoscopic surgery for benign gynecological diseases.Methods A cohort of 291 female patients diagnosed with benign gynecological diseases were enrolled from Beijing Ji⁃shuitan Hospital affiliated with Capital Medical University from March 2022 to August 2023 and Peking University Inter⁃national Hospital from September 2020 to July 2021.The patients were divided into three groups(adnexal group,uterine group and total hysterectomy group)based on the type of surgery using block randomization.Within each block,patients were randomly assigned to either the study group or the control group at a 1∶1 ratio.Both groups were administered iden⁃tical anesthesia induction and intraoperative nonsteroidal anti-inflammatory drugs(NSAIDs)for prophylactic analgesia.The study group received pre-incisional and postoperative ropivacaine for local infiltration anesthesia,in addition to postoperative NSAIDs for prophylactic analgesia.The control group did not receive local infiltration anesthesia and did not receive routine analgesia postoperatively(unless requested by the patient,in which self-controlled analgesia pump was provided).Postoperative Visual Analogue Scale/Score(VAS)and the incidence of postoperative nausea and vomiting(PONV)were evaluated at 2h,6h,24h,and 48h.Results The study group exhibited statistically significant re⁃ductions in VAS scores at the same condition 6h and at static state 24h postoperatively compared to the control group(P<0.05),and the VAS scores at the same condi⁃tion 2h、6h and at static state 24h postoperatively were significantly lower in the study group compared to patients in the control group who received analgesia pump(P<0.05).The incidence of nausea(35.2%vs.19.6%)and vomiting(27.8%vs.11.2%)was higher in the control group using analgesia pump compared to the study group(P<0.05).Conclusion In laparoscopic surgical interventions for benign gynecological diseases,multi-modal analgesic under the ERAS para⁃digm demonstrated superior analgesic efficacy and patient comfort relative to traditional analgesic regeien.The first 24 hours postoperatively represent the optimal window for pain management.