乳腺癌ERAS围手术期疼痛变化规律的研究  

Research about variation of perioperative pain during enhanced recovery after surgery in breast cancer

作　　者：夏丽婷 柳思雨 韦田福[1] 唐小其 李富[1] 曾健[1] XIA Li-ting;LIU Si-yu;WEI Tian-fu;TANG Xiao-qi;LI Fu;ZENG Jian(Department of gastrointestinal and glandular surgery,First affiliated hospital of Guangxi Medical University,Nanning,Guangxi,530021,China)

机构地区：[1]广西医科大学第一附属医院胃肠腺体外科,广西南宁530021

出　　处：《蛇志》2020年第1期57-60,71,共5页Journal of Snake

基　　金：广西壮族自治区卫计委自筹经费科研课题(编号:Z2016693);广西重点研发计划项目(编号:桂科AB18126054)。

摘　　要：目的探讨乳腺癌ERAS围手术期疼痛变化的规律。方法选取广西医科大学第一附属医院胃肠腺体外科2018年10月~2019年1月收治的98例按乳腺癌快速康复外科(Enhanced Recovery After Surgery,ERAS)流程实施围手术期管理的乳腺癌患者为ERAS组,回顾性收集2015年7~10月按常规围手术期管理的乳腺癌手术患者99例作为传统组。通过数字评分法(numerical rating scale,NRS)对两组患者术后疼痛程度进行评分,并分析不同手术方式对疼痛程度、疼痛部位及疼痛性质的影响。结果ERAS组术后6、24、48 h疼痛评分均明显低于传统组(P<0.05)。ERAS组不同手术方式的乳腺癌患者术后2、24 h疼痛评分比较,差异有显著统计学意义(P<0.05),其中术后2 h疼痛评分由高至低依次为保乳+腋清、保乳+SLNB、全切+SLNB及全切+腋清;术后24 h疼痛评分由高至低依次为保乳+腋清、全切+SLNB、保乳+SLNB及全切+腋清。两组乳腺癌患者术后不同时间的疼痛部位和疼痛性质均无明显统计学意义(P>0.05)。结论乳腺癌ERAS围手术期疼痛管理的止痛效果优于传统术后止痛,不同手术方式的乳腺癌术后疼痛变化规律有所不同,乳腺癌ERAS围手术期疼痛的管理需要实施个体化的镇痛。Objective To explore the variation of perioperative pain during Enhanced Recovery After Surgery(ERAS)in breast cancer.Methods 98 patients with breast cancer underwent procedure of ERAS during perioperative period in the First affiliated hospital of Guangxi Medical University from October to January 2019;99 breast cancer patients were performed conventional procedure during perioperative period in our hospital from July to October 2015.The postoperative pain degree of the two arms was assessed by the digital scoring method,and the influence of different operation on the degree,location and nature of pain were analyzed.Results The scores of pain in the ERAS arm at 6 h,24 h and 48 h were significantly lower than those of the conventional group(P<0.05),the scores were(0.73±0.926)(1.05±0.999),(0.99±0.739)and(1.56±0.785),(1.54±0.747),(1.25±0.993)respectively.In the ERAS group,the pain scores of the patients with breast cancer with different operation were significantly different at 2 and 24 hour(P<0.05).From high to low,the pain scores of 2 hour after operation were breast conserving surgery+axillary lymph node dissection,breast conserving surgery+sentinel lymph node biopsy,breast mastectomy+sentinel lymph node biopsy,breast mastectomy+axillary lymph node dissection respectively;From high to low,the pain scores of 24 hour after operation were breast conserving surgery+axillary lymph node dissection,breast mastectomy+sentinel lymph node biopsy,breast conserving surgery+sentinel lymph node biopsy,breast mastectomy+axillary lymph node dissection;the location and the nature of pain after breast cancer operation in ERAS procedure at different time were no significant difference(P>0.05).Conclusion The pain management of breast cancer during perioperative period in ERAS procedureis better than in traditional way.The variation of perioperative pain in different breast cancer is different,and the management of perioperative pain in ERAS procedure of breast cancer needs to carry out the individual analgesia.

关 键 词：快速康复外科 乳腺癌 围手术期 疼痛 

分 类 号：R737.9[医药卫生—肿瘤]