多模式镇痛在加速康复外科胃肠道肿瘤手术患者中的应用

Multimodal analgesia in enhanced recovery after surgery in patients undergoing gastrointestinal tumor surgery

目的探讨多模式镇痛用于加速康复外科胃肠道肿瘤手术患者术后镇痛的效果。方法选择2017年8月—2018年7月在江苏大学附属医院择期于全身麻醉下行腹腔镜结直肠手术或腹腔镜胃癌根治术且术后需镇痛的胃肠道肿瘤患者50例,随机分为多模式镇痛组和单一模式镇痛组,每组25例。多模式镇痛组于麻醉诱导前静脉注射帕瑞昔布钠40 mg,术毕关腹后于超声引导下行双侧腹横肌平面阻滞麻醉,经静脉自控镇痛泵注射布托啡诺注射液3.5μg/(kg·h)+盐酸右美托咪定0.08μg/(kg·h);单一模式镇痛组经静脉自控镇痛泵注射枸橼酸舒芬太尼注射液0.05μg/(kg·h)。分别于术后1、6、12、24、48 h应用疼痛VAS评分评价两组患者的镇痛效果,测定术后24 h血清IL-6水平,记录首次下床活动时间、首次进食流质时间、首次排气时间、住院天数、术后48 h内静脉自控镇痛泵有效按压次数和不良反应发生情况。结果多模式镇痛组术后1、6、12、24、48 h的疼痛VAS评分和术后24 h血清IL-6水平均显著低于单一模式镇痛组(P值均<0.05),术后首次下床活动时间、首次进食流质时间、首次排气时间、住院天数均显著短于单一模式镇痛组(P值均<0.05),术后48 h内静脉自控镇痛泵有效按压次数显著少于单一模式镇痛组(P<0.05)。多模式镇痛组不良反应发生率有低于单一模式镇痛组的趋势,但差异无统计学意义(P>0.05)。结论胃肠道肿瘤术后采用多模式镇痛可有效缓解患者术后疼痛,加速患者康复,值得在临床推广应用。

Objective To investigate the clinical effect of multimodal analgesia in enhanced recovery after surgery(ERAS)in patients undergoing gastrointestinal surgery for postoperative analgesia.Methods Fifty patients with gastrointestinal tumors admitted to our hospital from August 2017 to July 2018 were randomly divided into multimodal analgesia group and single mode analgesia group.There were 25 patients in each group.Patients in multimodal analgesia group were given intravenous injection of parecoxib sodium 40 mg before anesthesia induction,followed by ultrasound guided bilateral transversus abdominis plane(TAP)block after surgery and butorphanol tartrate injection 3.5μg/(kg·h)+dexmedetomidine hydrochloride 0.08μg/(kg·h)by intravenous controlled analgesia pump.A conventional intravenous self-controlled analgesia pump(sufentanil 0.05μg/[kg·h])was used in single mode analgesia group.Visual analogue scale(VAS)was used to evaluate the analgesic effect of the two groups at 1,6,12,24 and 48 h after surgery.24-hour interleukin-6(IL-6)level,first time to get out of bed,first time of eating liquid food,first time of postoperative exhaust,length of hospital stay,press times of self-controlled pump and adverse reactions were recorded.Results The VAS scores at 1,6,12,24,and 48 h after surgery and serum IL-6 levels at 24 h after surgery were significantly lower in the multimodal analgesia group than those in the single mode analgesia group(all P<0.05).The first time to get out of bed,first time of eating liquid food,first time of postoperative exhaust,and hospital stay were significantly shorter in the multimodal analgesia group than those in the single mode analgesia group(all P<0.05).The press times of self-controlled pump in the multimodal analgesia group was significantly lower than that in the single mode analgesia group within 48 h after surgery(P<0.05).There was no statistical difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion Multimodal analgesia in patients with gastrointestinal cancer can effectively relieve postoperative pain and accelerate the recovery.Therefore,it is worthy of clinical application.(Shanghai Med J,2019,42:213-217)