多模式止痛对机器人45例远端胃切除术后肠功能的影响  

Effects of multimodal analgesia on the intestinal function of 45 patients who received robotic distal gastrectomy

作　　者：赵健 韩晓玲[2] 王刚[2] 刘江 周嘉晖 王海锋 江志伟 黎介寿 ZHAO Jian;HAN Xiaoling;WANG Gang;LIU Jiang;ZHOU Jiahui;WANG Haifeng;JIANG Zhiwei;LI Jieshou(Research Institute of General Surgery,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,Jiangsu,China;Department of General Surgery,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,Jiangsu,China;Research Institute of General Surgery,Jinling Clinical Medical College,Nanjing Medical University,Nanjing 210002,Jiangsu,China)

机构地区：[1]南京大学医学院附属金陵医院普通外科研究所,江苏南京210002 [2]江苏省中医院普通外科,江苏南京210029 [3]南京医科大学金陵临床医学院普通外科研究所,江苏南京210002

出　　处：《山东大学学报（医学版）》2019年第9期43-47,共5页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81500417);江苏省社会发展项目(BE2015687)

摘　　要：目的探讨在加速康复外科理念指导下多模式止痛技术对接受机器人远端胃切除患者术后肠功能恢复的影响。方法回顾性分析2017年11月至2018年6月期间45例在南京大学医学院附属金陵医院普通外科行机器人远端胃切除的胃癌患者,根据围手术期所用止痛方法,分为多模式止痛(MMA)组(n=25)和患者自控静脉止痛(PCIA)组(n=20)。MMA组止痛措施包括:术毕缝皮前切口罗哌卡因浸润、术后静脉注射帕瑞昔布钠、小剂量甲泼尼龙及口服氨酚羟考酮片;PCIA组术后采用患者自控曲马多静脉止痛泵止痛。观测术后肠功能恢复状况、止痛效果等指标。结果MMA组患者术后首次排气时间[2(2,3)d vs 3(2,3.5)d,Z=-2.302,P=0.021]、术后恢复半流饮食时间[2(2,3)d vs 3.5(3,4)d,Z=-3.032,P=0.002]、术后首次下床活动时间[1(1,1)d vs 2(1.5,2)d,Z=-5.217,P<0.001]及术后住院时间[4(4,5)d vs 5(4,7)d,Z=-2.501,P=0.012]短于PCIA组患者,差异均有统计学意义;而两组并发症发生率及术后1~3 d咳嗽时和卧床时VAS评分差异均无统计学意义。结论在加速康复外科理念指导下,多模式止痛技术可加快机器人远端胃切除的患者术后肠功能恢复速度,其止痛效果与患者自控静脉止痛相仿。Objective To explore the effects of multimodal analgesia on the intestinal function after robotic distal gastrectomy under an enhanced recovery after surgery(ERAS)pathway.Methods During Nov.2017 and June 2018,45 patients who received robotic distal gastrectomy were divided into the multimodal analgesia(MMA)group and patient-controlled intravenous analgesia(PCIA)group.Analgesic methods in the MMA group consisted of incision infiltration with ropivacaine before closure,intravenous injection of parecoxib after the operation,intravenous injection of methylprednisolone after the surgery,and oral administration of oxycodone/acetaminophen tablets.Patients in PCIA group were given PCIA pump with tramadol.Postoperative intestinal function and analgesic effects were observed.Results In the MMA and PCIA groups,the time to first flatus was[2(2,3)d vs 3(2,3.5)d,Z=-2.302,P=0.021],time to recover semi-liquid diet was[2(2,3)d vs 3.5(3,4)d,Z=-3.032,P=0.002],time to first off-bed activity was[1(1,1)d vs 2(1.5,2)d,Z=-5.217,P<0.001],and postoperative length of stay was[4(4,5)d vs 5(4,7)d,Z=-2.501,P=0.012].Complication rates in two groups were similar.From day 1 to the day 3 after surgery,VAS scores were similar in the two groups on coughing and at rest.Conclusion Under an ERAS pathway,multimodal analgesia accelerates intestinal function recovery after robotic distal gastrectomy,and its analgesic effects are similar to PCIA.

关 键 词：多模式止痛 机器人手术 加速康复外科 肠功能 

分 类 号：R619[医药卫生—外科学]