急性疼痛管理在胸科手术中镇痛的效果评价  

Evaluation of the analgesic effect of Acute Pain Service in thoracic surgery

作　　者：吴丹 夏燕飞[1] 杨晓明 王红梅[1] 钱江[1] 刘艳 Wu Dan;Xia Yanfei;Yang Xiaoming;Wang Hongmei;Qian Jian;Liu Yan(Department of Anesthesiology,Zhejiang Hospital,Hangzhou,310030,China;Department of Anesthesiology,Special Medical Center of PLA Air Force,Beijing,100142,China)

机构地区：[1]浙江医院麻醉科,杭州310030 [2]解放军空军医学特色中心麻醉科,北京100142

出　　处：《中华医学杂志》2020年第38期3010-3013,共4页National Medical Journal of China

摘　　要：目的观察急性疼痛服务(APS)用于胸科手术术后的镇痛效果、并发症及患者满意度。方法对2017年1月至2019年12月于浙江医院行胸科手术264例患者进行回顾性分析,根据手术方式分为开胸组(O组,90例)和胸腔镜组(T组,174例)。根据有无采用APS,O组分为无APS组(O1组)和APS组(O2组),T组分为无APS组(T1组)和APS组(T2组),分别观察O1和O2组、T1和T2组术后镇痛的效果、并发症及患者满意度有无差异。结果静息状态下O2组与O1组数字疼痛评分(NRS)比较,出麻醉恢复室(PACU)后0(0.92±0.50与1.59±0.62)、4(0.92±0.50与2.06±1.03)、8(0.92±0.50与2.18±1.13)、12(0.92±0.50与2.47±1.42)、24(1.00±0.71与2.53±1.42)、48 h(1.00±0.71与2.35±1.80),均显著<O1组,均P<0.05;活动状态下,O2组出PACU后0、4、8、12、24、48、72 h(P=0.019),NRS也均显著<O1组,均P<0.05。静息状态下,T2组出PACU后4、8、12、24 h(P=0.013),NRS均显著<T1组,均P<0.05。活动状态下,T2组出PACU后4、8、12、24、48 h(P=0.002),NRS也均显著<T1组,均P<0.05。结论APS镇痛模式较普通镇痛模式能显著减轻胸科术后疼痛。Objective To observe the analgesic effect,complication and patient satisfaction of Acute Pain Service(APS)after thoracic surgery.Methods The clinical data were collected from 264 patients who underwent different thoracic surgery from January 2017 until December 2019 retrospectively.They were divided into thoracotomy group(group O)and thoracoscopy surgery group(group T).There were 90 cases in group O and 174 cases in group T.According to the use of APS,the group O is divided into the no-APS group(group O1)and the APS group(group O2),the group T is divided into the no-APS group(group T1)and the APS group(group T2).The effect of postoperative analgesia,the incidence of nausea and vomiting and the satisfaction of patients were compared between group O1 and group O2,group T1 and group T2,respectively.Results In the resting state,the Numeric Rating Scales(NRS)scores of the group O2 at 0 h(0.92±0.50 vs 1.59±0.62),4 h(0.92±0.50 vs 2.06±1.03),8 h(0.92±0.50 vs 2.18±1.13),12 h(0.92±0.50 vs 2.47±1.42),24 h(1.00±0.71 vs 2.53±1.42),and 48 h(1.00±0.71 vs 2.35±1.80)after leaving the Anesthesia Recovery Room(PACU)were significantly lower than those of the group O1(all P<0.05),and in the active state,the NRS scores of the group O2 at 0 h(P=0.023),4 h(P=0.001),8 h(P=0.000),12 h(P=0.001),24 h(P=0.000),48 h(P=0.000),and 72 h(P=0.019)after leaving the PACU were significantly lower than those of the group O1(all P<0.05).In the resting state,the NRS scores of the group T2 at 4 h(P=0.029),8 h(P=0.008),12 h(P=0.006),and 24 h(P=0.013)after leaving the PACU were significantly lower than those of the group T1(all P<0.05).In the active state,the NRS scores of the group T2 at 4 h(P=0.019),8 h(P=0.000),12 h(P=0.001),24 h(P=0.002),and 48 h(P=0.002)after leaving the PACU were significantly lower than those of the group T1(all P<0.05).Conclusion APS can significantly reduce the NRS scores after thoracotomy and thoracoscopic surgery compared to ordinary analgesia model.

关 键 词：疼痛 卫生服务 开胸术 胸腔镜 

分 类 号：R614[医药卫生—麻醉学]