骶骨肿瘤切除术围术期疼痛及管理现状分析  

Prevalence and management of perioperative pain in patients undergoing sacral tumor resection

作　　者：张庆芬 吴雅青 冯艺[1] ZHANG Qing-fen;WU Ya-qing;FENG Yi(Department of Anesthesiology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院麻醉科,100044

出　　处：《天津医药》2020年第12期1205-1210,共6页Tianjin Medical Journal

摘　　要：目的调查骶骨肿瘤切除术围术期疼痛现状和镇痛策略,探索围术期镇痛管理中可改进的方面。方法回顾性分析2018年1月—2019年12月行骶骨肿瘤切除术患者的临床资料。主要观察指标包括术后疼痛程度及术后阿片类药物用量,次要指标包括术前疼痛及阿片类药物使用情况、术中及术后镇痛方案、术后住院时间及手术并发症等。结果共纳入215例骶骨肿瘤手术患者,其中术前存在慢性疼痛者126例(58.6%),术前使用阿片类药物者49例(22.8%)。术中及术后镇痛以单一阿片类药物镇痛模式为主。术后第1天中、重度疼痛者112例(53.3%),疼痛程度与患者术前疼痛情况及阿片类药物使用情况、肿瘤位置、肿瘤切除方式等均无相关性(P>0.05)。术后阿片类药物用量与疼痛程度正相关(P<0.05)。术后7 d仍需服用阿片类药物者占42.3%,出院时降至26.0%。术后住院时间与术后疼痛程度呈正相关(P<0.05)。与术前未使用阿片类药物者相比,术前使用阿片类药物者术后7 d累积阿片类用量、术后7 d及出院时仍需服用阿片类药物者比例显著增高(P<0.05)。结论骶骨肿瘤患者术前疼痛发生率高,术后疼痛剧烈,阿片类药物需求量大,需要进一步优化镇痛模式,改进术后镇痛管理质量。Objective To investigate the prevalence and management of perioperative pain in patients undergoing sacral tumor resection,and identify potential ways,in which pain management can be improved.Methods The clinical data of 215 patients undergoing sacral tumor resection from January 2018 to December 2019 were collected.The main observation indicators included postoperative pain and postoperative opioid consumption,and secondary indicators included preoperative pain,analgesic regimes during and after surgery,length of hospital stay after surgery and surgery complications.Results In 215 patients,there were 126 patients(58.6%)presented with chronic pain and forty nine patients(22.8%)required opioids preoperatively.Opioid-only analgesia was the mainstay of analgesia modality during and after surgery.On the first day after surgery,112 patients(53.3%)suffered from moderate-severe pain.Postoperative pain severity was not associated with preoperative pain,tumor location or surgery procedures(P>0.05).The postoperative opioid dosage was positively correlated with the pain severity(P<0.05).By the 7 days after surgery,42.3%of patients still required opioids,and the proportion decreased to 26.0%by discharge.The length of hospital stay after surgery was positively related with postoperative pain severity(P<0.05).Compared with patients who were not on preoperative opioids,patients on preoperative opioids required higher doses of opioids in the first 7 days after surgery(P<0.05),and the proportion of patients required opioids 7 days after surgery and at discharge were increased(P<0.05).Conclusion Patients undergoing sacral tumor resection have a higher incidence of preoperative pain,severe postoperative pain and a large demand for opioids.It is necessary to further optimize the analgesia mode and improve the quality of postoperative analgesia management.

关 键 词：骶骨 骨肿瘤 疼痛管理 疼痛 手术后 镇痛药 阿片类 骶骨肿瘤切除术 多模式镇痛 

分 类 号：R614[医药卫生—麻醉学]