多学科疼痛管理模式对结直肠手术患者PCIA镇痛及康复效果的影响  

The influence of multidisciplinary pain management model on the PCIA analgesic effect and rehabilitation for colorectal surgery patients

作　　者：熊鸣琴 邓建冬 龚双喜 曹春乐 钟畅 XIONG Mingqin;DENG Jiandong;GONG Shuangxi;CAO Chunle;ZHONG Chang(Department of Gastroenterology,Changsha Hospital Affiliated to Xiangya Medical College,Central South University,Changsha 410005,Hunan,China;Department of Anesthesiology,Changsha Hospital Affiliated to Xiangya Medical College,Central South University,Changsha 410005,Hunan,China)

机构地区：[1]中南大学湘雅医学院附属长沙医院胃肠外科,湖南长沙410005 [2]中南大学湘雅医学院附属长沙医院麻醉科,湖南长沙410005

出　　处：《中国现代手术学杂志》2024年第4期334-338,共5页Chinese Journal of Modern Operative Surgery

基　　金：2021年度湖南省卫生健康委科研立项课题(202114021125)。

摘　　要：目的探讨多学科疼痛管理模式对结直肠手术患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)镇痛及康复效果的影响。方法采用病例对照研究,选取我院2022年1月至2022年12月接受结直肠手术患者38例作为观察组,2021年1月至2021年12月接受结直肠手术患者40例作为对照组。两组手术患者均接受PCIA镇痛,对照组采用常规疼痛管理模式,观察组采用基于加速康复外科的多学科疼痛管理模式。比较两组患者术后6h、12h、24h、48h及首次下床活动时疼痛视觉模拟评分(visual analog scale,VAS),PCIA平均按压次数、镇痛药物使用量、不良反应发生率,以及首次排气时间、首次下床活动时间、住院时间等指标。结果①镇痛效果:观察组在术后6h、12h及首次下床活动时VAS均低于对照组(P<0.05);观察组PCIA平均按压次数、镇痛药物使用量均明显多于对照组(P<0.05),不良反应发生率低于对照组(P<0.05);②康复指标:观察组患者首次排气时间、首次下床活动时间早于对照组,平均住院时间较对照组缩短(P<0.05)。结论多学科疼痛管理模式可改善PCIA镇痛效果,促进患者康复,值得推广应用。Objective To explore the influence of multidisciplinary pain management model on the PCIA analgesic effect rehabilitation of colorectal surgery patients.Methods A non-synchronous case control study was conducted.40 patients who underwent colorectal surgery in our hospital from January 2021 to December 2021 were selected as the control group,and 38 patients who underwent colorectal surgery from January 2021 to December 2022 were selected as the observation group.The control group received conventional pain management,while the observation group received PCIA interventions of the multidisciplinary pain management model based on the concept of accelerated recovery surgery.Visual analog scales(VAS)at postoperative 6h,12h,24h,48h,and at the first off-bed mobilization were compared between the two groups.PCIA compression numbers, analgesic drug usage, incidence of adverse reactions, as well as indicators such as the first exhausttime, the first time off-bed mobilization, and the length of hospital stay were compared between the two groups.Results VAS of the observation group at 6h, 12h and at the first off-bed mobilization was lower than that ofthe control group(P<0. 05). PCIA compression numbers and analgesic drug usage were more than that ofthe control group(P<0. 05). And the adverse reaction rate was lower than the control group (P<0. 05). Thefirst exhaust time, the first off-bed time and average hospitalization time of the observation group was shorterthan that of the control group (P<0. 05). Conclusion The PCIA multidisciplinary pain management modelcan improve the analgesic effect of PCIA and promote the recovery of colorectal surgery patients, which is worthpopularizing and applying.

关 键 词：疼痛管理 多学科协作 加速康复外科 患者自控静脉镇痛 结直肠手术 

分 类 号：R473.6[医药卫生—护理学]