多模式镇痛在OSAHS同期多平面手术后的应用  

Multimodal analgesic analgesia in patients with obstructive sleep apnea hypopnea syndrome with multiple planar surgery

作　　者：苏静[1] 田君海[1] 高欣欣 吴永峰 祖金美[1] 董凯峰[1] 段立广[2] SU Jing;TIAN Junhai;GAO Xinxin;WU Yongfeng;ZUJinmei;DONG Kaifeng;DUAN Liguang(Department of Otorhinolaryngology, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China;Department of Pharmacy, the First Hospital of Hebei Medical University)

机构地区：[1]河北医科大学第一医院耳鼻咽喉科,石家庄050031 [2]河北医科大学第一医院药学部

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第11期850-853,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：河北省医学科学研究重点科技研究计划(No:20170495)

摘　　要：目的:观察多模式镇痛在行同期多平面手术的OSAHS患者中的应用价值。方法:收集90例伴有舌体肥厚或者伴舌根淋巴组织增生的OSAHS患者,均同期行改良悬雍垂腭咽成形术及舌根部分切除术,或同时联合舌体消融术,随机分为2组,每组45例。多模式镇痛组于手术前0.5h给予帕瑞昔布钠40mg静脉注射,术后给予布地奈德氧气驱动雾化吸入治疗,术后24、48、72h给予七叶皂苷钠10mg入液静脉滴注;对照组不做上述处理。2组术后均予以40mg帕瑞昔布钠静脉滴注,每日2次,疗程为4d。对2组患者术后疼痛进行VAS评分,记录咽部黏膜消肿的时间及首次进食流食时间、并观察其术后恶心、呕吐等不良反应的发生情况。结果:2组患者年龄、性别、BMI、术中出血量、手术时间等比较均无统计学意义(P>0.05);多模式镇痛组术后24、48、72、96hVAS评分较对照组均下降明显,差异有统计学意义(P<0.05);多模式镇痛组悬雍垂消肿时间及首次进食时间较对照组缩短明显,分别为(5.44±0.88)d和(7.68±0.89)d(t=12.01,P<0.01);(30.1±7.3)h和(36.5±7.0)h(t=4.25,P<0.01)。结论:多模式镇痛应用于OSAHS患者同期多平面手术后镇痛效果肯定,有效降低了术后疼痛,缩短了术后消肿时间,提高了手术的依从性和安全性。Objective：To observe the value of multimodal analgesia in patients with OSAHS undergoing multiplanar surgery.Method：A total number of 90 patients with obstructive sleep apnea hypopnea syndrome with tongue hypertrophy or hyperplasia of the root lymphoid tissue were collected.All patients underwent improved uvulatopharyngeal angioplasty（H-UPPP）and tongue root partial resection,or simultaneous tongue ablation at the same time,and they were randomly divided into two groups,45 patients in each group.In multi-modal analgesic group,the parrixibub sodium 40 mg were given intravenously 0.5 hbefore surgery,and oxygen budesonide aerosol inhalation therapy was given after surgery.Besides,sodium aescinate 10 mg was given intravenously 24,48,72 hafter surgery,respectively.The control group did not do the above treatment.Both groups received 40 mg paradoxes sodium hydrostatic Bid for 4 days.To perform VAS on two groups of patients,uvula swelling time and first time to eat were recorded,and the symptoms of postoperative nausea and vomiting were observed.Result：The general conditions of the two groups of patients,including age,sex,body mass index,intraoperative blood loss,and operative time,were not statistically significant（all of the P〉0.05）.The scores of 24,48,72,96 h VAS in multi-mode analgesic group were lower than those in control group after the operation of multi-mode analgesia,and the difference was statistically significant（P〈0.05）.The duration of the swelling time of the uvula in the multi-mode analgesic group was significantly shorter than that in the control group,and the difference was statistically significant（5.44±0.88）d compared with（7.68±0.89）d（t=12.01,P〈0.01）;（30.1±7.3）h compared with（36.5±7.0）h,（t=4.25,P〈0.01）.Conclusion：Multi-mode analgesia is effective for OSAHS patients after multi-planar surgery.It effectively reduces postoperative pain,shortened postoperative swelling time,and improves the surgical compliance and safety.

关 键 词：睡眠呼吸暂停低通气综合征 阻塞性 同期多平面手术 多模式镇痛 

分 类 号：R563.8[医药卫生—呼吸系统]