腹腔镜胆囊切除胆总管探查术后多模式镇痛的优化策略  

Optimal strategy of multimodal analgesia after laparoscopic cholecystectomy and exploration of common bile duct

作　　者：刘力玮 郑亚民[1] 刘东斌[1] 王悦华[1] 刘家峰[1] 仝小刚[1] 江华[1] 曹锋[1] 姚贵宾 徐大华[1] LIU Liwei;ZHENG Ya-min;LIU Dong-bin(Department of General Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100055,China;The First Clinical Medical College,Capital Medical University)

机构地区：[1]首都医科大学宣武医院普通外科,北京100053 [2]首都医科大学第一临床医学院

出　　处：《腹腔镜外科杂志》2020年第10期753-756,共4页Journal of Laparoscopic Surgery

摘　　要：目的:总结腹腔镜胆囊切除、胆总管探查术后多模式镇痛的优化策略。方法:采用前瞻性随机对照研究,研究对象为2017年1月1日至2019年12月31日收治的胆囊结石合并胆总管结石接受腹腔镜胆囊切除、胆总管探查术的168例患者。信封法随机分为两组,研究组(n=85)采用手术切口局部浸润镇痛联合选择性COX-2抑制剂全身镇痛,对照组(n=83)采用手术切口局部浸润镇痛联合阿片类药物止痛泵全身镇痛。对比两组镇痛效果、安全性及卫生经济学指标。结果:两组患者性别、年龄、体重指数、胆总管结石数量与大小、胆总管直径、伴发急性胆管炎、既往腹部手术史、手术时间、术中出血量差异无统计学意义(P>0.05)。术后24 h、术后48 h静息痛与运动痛及术后拔除胃管时间、拔除尿管时间、影响睡眠质量、术后消化道出血、住院时间、住院费用差异亦无统计学意义(P>0.05)。研究组术后首次下床活动时间、术后肠蠕动恢复时间早于对照组,术后恶心、呕吐、头晕比例低,镇痛治疗费用低,差异有统计学意义(P<0.05)。结论:腹腔镜胆囊切除、胆总管探查术后,联合局部切口浸润镇痛与非甾体类抗炎药可获得满意的疼痛控制效果。与阿片类药物止痛泵相比,头晕、恶心、呕吐等不良反应发生率更低,止痛花费更少。Objective:To study the optimal strategy of multimodal analgesia after laparoscopic cholecystectomy and common bile duct exploration.Methods:A prospective randomized controlled study was conducted in 168 patients with cholecystolithiasis and choledocholithiasis who underwent laparoscopic cholecystectomy and common bile duct exploration from Jan.1,2017 to Dec.31,2019.Envelope method was used to randomly divide patients into two groups.In the study group(n=85),local infiltration analgesia combined with selective COX-2 inhibitor was used,while in the control group(n=83),local infiltration analgesia combined with opioid analgesic pump was used.The analgesic effect,safety and health economic indicators were compared between two groups.Results:There was no significant difference in gender,age,body mass index,number and size of choledocholithiasis,diameter of common bile duct,acute cholangitis,previous abdominal operation,operative time and intraoperative blood loss between the two groups(P>0.05).There was no significant difference in 24 h and 48 h rest pain and exercise pain,time of gastric tube removal,time of urinary tube removal,influence on sleep quality,postoperative gastrointestinal bleeding,hospitalization time or hospitalization cost between the two groups(P>0.05).Compared with the control group,the patients in the study group had earlier first ambulation and recovery of postoperative intestinal peristalsis,lower proportion of postoperative nausea,vomiting and dizziness,and significantly lower cost of analgesic treatment(P<0.05).Conclusions:After laparoscopic cholecystectomy and common bile duct exploration,local incision infiltration analgesia combined with non-steroidal anti-inflammatory drug can achieve satisfactory pain control effect.Compared with opioid analgesic pump,the incidence of dizziness,nausea,vomiting and other adverse reaction is lower,and the cost of analgesia is less.

关 键 词：胆囊结石病 胆总管结石 腹腔镜检查 胆总管探查术 多模式镇痛 优化策略 

分 类 号：R657.4[医药卫生—外科学]