加速康复外科理念下标准化多模式镇痛对上腹部大手术术后阿片类药物使用量的影响  

Effect of standardized multimodal analgesia on opioid consumption after major upper abdominal surgery under enhanced recovery after surgery pathway

作　　者：陈瑜 玉红[1] 李程玉 陈东旭 杨磊[1] 刘飞[1] 李茜[1] CHEN Yu;YU Hong;LI Chengyu;CHEN Dongxu;YANG Lei;LIU Fei;LI Qian(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Anesthesiology,Sichuan Provincial Maternity and Child Health Care Hospital,Chengdu 610041,P.R.Chin)

机构地区：[1]四川大学华西医院麻醉科,成都610041 [2]四川省妇幼保健院麻醉科,成都610041

出　　处：《中国普外基础与临床杂志》2022年第4期475-480,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川大学华西医院临床研究孵化项目(项目编号:2018HXFH025);四川省科技计划项目(项目编号:2019YFS0536)。

摘　　要：目的探索加速康复外科理念下,标准化多模式镇痛对上腹部大手术患者术后阿片类药物使用量的影响。方法前瞻性纳入2020年8月至2020年11月期间于四川大学华西医院行上腹部大手术的患者按是否接受标准化多模式镇痛,将患者分为标准化多模式镇痛组(n=175)和对照组(n=632)。标准化多模式镇痛方案根据美国《术后疼痛管理指南》定义为术前、术后使用非甾体类抗炎药,联合围麻醉期区域神经阻滞、切口浸润麻醉或鞘内阻滞。观察2组患者术后阿片类药物使用量(吗啡当量)、术后静息及活动时疼痛评分以及术后康复情况。结果标准化多模式镇痛组患者的术后72 h阿片类药物使用量低于对照组(中位数:51 mg比85 mg,P<0.001)。此外,标准化多模式镇痛组的术后24、48、72 h静息及活动时疼痛评分更低(P<0.05),术后首次排气时间、首次下床活动时间和术后住院时间更短(P<0.05),术后5 d生活质量评分更高(P<0.05)。2组患者对镇痛效果的满意度及术后5 d不良事件发生率比较差异无统计学意义(P>0.05)。矫正混杂因素后,多重线性回归结果显示,标准化多模式镇痛与术后72 h阿片类药物用量减少相关(P<0.001)。结论标准化多模式镇痛可以减少上腹部大手术患者术后阿片类药物的用量,加速外科康复。Objective To explore the effect of standardized multimodal analgesia(SMA)on opioid consumption after major upper abdominal surgery under enhanced recovery after surgery pathway.Methods Patients who underwent major upper abdominal surgery in the West China Hospital of Sichuan University between August and November 2020 were included prospectively.The patients were divided into two groups:SMA group(n=175)and control group(n=632).The SMA was defined as preoperative and postoperative use of non-steroidal anti-inflammatory drugs,combined with regional anesthesia,local anesthetic wound infiltration or intrathecal opioid.The postoperative opioid consumption in oral morphine equivalents,the pain scores on movement and at rest,the postoperative rehabilitation were recorded and compared between the two groups.Results Patients in the SMA group had a lower opioid consumption during the first 72 h compared to patients in the control group(median:51 mg vs.85 mg,P<0.001).The pain scores on movement and at rest at 24,48,72 h after surgery in the SMA group were lower than those in the control group(P<0.05).Time to first flatus,time to first ambulation,postoperative hospital stay in the SMA group were significantly shorter than those in the control group(P<0.05),and the quality of life scores at 5 d after surgery increased significantly(P<0.05).The satisfaction with analgesia and the incidence of adverse effects on day 5 after surgery had no statistical significances between the two groups(P>0.05).After controlling for confounding factors,multiple linear regression analysis showed that SMA was associated with less opioid consumption on hour 72 after surgery(P<0.001).Conclusion SMA can reduce postoperative opioid consumption in patients undergoing major upper abdominal surgery.

关 键 词：多模式镇痛 加速康复外科 上腹部大手术 阿片类药物使用量 

分 类 号：R614[医药卫生—麻醉学]