开腹肝切除围术期路径化多模式镇痛用药管理及其实施效果评价

Effectiveness of perioperative path-based multimodal analgesic regimens for open hepatectomy

目的研究开腹肝切除围术期路径化多模式镇痛用药管理策略及其实施效果。方法选取2020年4月至2021年5月医院肝胆外科行开腹肝切除术的患者216例进行研究,将路径化用药方案实施前(2020年4月至2020年10月)139例患者纳入观察组,路径化用药方案实施后(2020年11月至2021年5月)77例患者纳入研究组,比较2组术后镇痛效果及不良反应等指标。结果研究组术后中重度疼痛控制率明显高于观察组(83.1%vs 69.8%,P<0.05)。术后6 h疼痛评分(2.0分vs 2.0分,P>0.05),24 h疼痛评分(1.0分vs 1.0分,P>0.05)以及术后恶心呕吐发生率(40.3%vs 43.9%,P>0.05)在2组间差异无统计学意义,但研究组术后48 h疼痛评分(0.0分vs 1.0分,P<0.01)以及72 h疼痛评分(0.0分vs 0.0分,P<0.01)明显低于观察组,且住院时长更短(15d vs 19 d,P<0.01),胃肠道功能障碍发生率更低(26.0%vs 41.0%,P<0.05)。结论开腹肝切除围术期路径化多模式镇痛用药方案能优化术后疼痛控制,改善患者预后。

AIM To study the effectiveness of a perioperative multimodal analgesia management and medication regimen for patients undergoing open hepatectomy.METHODS A total of 216 patients who underwent open hepatectomy in the hepatobiliary surgery department were recruited in the hospital from April 2020 to May 2021.Of these,139 patients who did not follow the regimen were included in the observation group(from April 2020 to October 2020),while 77 patients were included in the study group(from November 2020 to May 2021),following the multimodal analgesia medication regimen.Postoperative analgesic outcomes and adverse events were compared between 2 groups.RESULTS The control rate of moderate to severe postoperative pain in the study group was significantly higher than that in the observation group(83.1%vs 69.8%,P<0.05).There was no significant difference between the groups in pain scores at 6 h(2.0 vs 2.0,P>0.05)and 24 h(1.0 vs 1.0,P>0.05)post-surgery,as well as the incidence of postoperative nausea and vomiting(40.3%vs 43.9%,P>0.05).However,pain scores at 48 h(0.0 vs 1.0,P<0.01)and 72 h(0.0 vs 0.0,P<0.01)post-surgery were significantly lower in the study group,and the hospitalization duration was shorter(15vs 19 days,P<0.01),with a lower incidence of gastrointestinal dysfunction(26.0%vs 41.0%,P<0.05).CONCLUSION The perioperative multimodal analgesia management and medication regimen for open hepatectomy can optimize postoperative pain control and improve patient outcomes.