多模式镇痛方案在腹腔镜袖状胃切除术后疼痛管理中的应用  

Application of multimodal analgesia regimen in postoperative pain management after laparoscopic sleeve gastrectomy

作　　者：陈敏 戴洪山 江志伟 李淑佩 姚妙诗 束雅春 CHEN Min;DAI Hongshan;JIANG Zhiwei;LI Shupei;YAO Miaoshi;SHU Yachun(Dept.of Pharmacy,Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,China;Dept.of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,China;Jiangsu Coastal Rehabilitation Hospital,Jiangsu Lianyungang 222042,China)

机构地区：[1]南京中医药大学附属医院/江苏省中医院药学部,南京210029 [2]南京中医药大学附属医院/江苏省中医院普通外科,南京210029 [3]江苏省海滨康复医院,江苏连云港222042

出　　处：《中国药房》2024年第21期2658-2662,共5页China Pharmacy

基　　金：江苏省中医药科技发展计划项目——重点项目(No.ZD201903);南京市医疗机构中药传统制剂研究立项项目(No.NJCCZJ-202303);第三批江苏省中医药领军人才培养项目(No.SLJ0311)。

摘　　要：目的探讨在加速康复外科理念指导下,多模式镇痛方案应用于腹腔镜袖状胃切除术患者术后的安全性、有效性和经济性。方法回顾性收集本院接受腹腔镜袖状胃切除术的减重患者数据。试验组患者采用多模式镇痛方案,即手术结束前,使用0.375%罗哌卡因局部浸润手术切口;术后静脉滴注氟比洛芬酯50 mg,每日2次;静脉滴注甲泼尼龙40 mg,每日1次;口服盐酸羟考酮缓释片10 mg,每日2次。对照组患者采用常规镇痛方案,即术后静脉滴注氟比洛芬酯100 mg,每日2次,日剂量为试验组的2倍;静脉注射地塞米松5 mg,每日1次。使用倾向性评分匹配法均衡两组基线资料,进而分别比较两组术后2、12、24、36 h运动状态和静息状态的疼痛评分,以及患者术后住院时间、总住院时间、术后首次下床时间、住院期间不良反应、住院期间药物总费用和抗菌药物费用。结果试验组术后2、24、36 h运动疼痛评分和2、12、24 h静息疼痛评分均显著低于对照组(P<0.05);术后首次下床时间、总住院时间、术后住院时间较对照组均显著缩短(P<0.05);肩背酸胀发生率、抗菌药物费用均显著低于对照组(P<0.05)。两组药物总不良反应发生率和住院期间药物总费用差异无统计学意义(P>0.05)。结论多模式镇痛方案镇痛效果显著,安全性好,且相比常规镇痛方案更具经济优势。OBJECTIVE To explore the safety,effectiveness and cost-effectiveness of a multimodal analgesic regimen in patients who underwent laparoscopic sleeve gastrectomy under the guidance of enhanced recovery after surgery principles.METHODS Data from weight loss patients who underwent laparoscopic sleeve gastrectomy at our hospital were retrospectively collected.The trial group patients received a multimodal analgesic regimen,which included the use of 0.375%ropivacaine for local infiltration of the surgical incision before the end of surgery;intravenous infusion of flurbiprofen axetil 50 mg twice daily;intravenous infusion of methylprednisolone 40 mg once daily and oral administration of extended-release hydrocodone hydrochloride tablets 10 mg twice daily after surgery.The control group patients received a conventional analgesic regimen,which included intravenous infusion of flurbiprofen axetil 100 mg twice daily,with a daily dose twice that of the trial group;and intravenous injection of dexamethasone 5 mg once daily.Propensity score matching was used to balance the baseline data between the two groups.Then the pain scores during movement and at rest at 2,12,24 and 36 hours postoperatively,as well as the length of postoperative hospital stay,total length of hospital stay,time to first ambulation after surgery,adverse reactions during hospitalization,total drug costs,and costs of antimicrobial drugs during hospitalization were compared between the two groups.RESULTS The trial group had significantly lower pain scores during movement at 2,24 and 36 hours postoperatively,and at rest at 2,12 and 24 hours postoperatively compared to the control group(P<0.05).The time to first ambulation after surgery,total length of hospital stay,and length of postoperative hospital stay were significantly shorter in the trial group compared to the control group(P<0.05).The incidence of shoulder and back soreness,and costs of antimicrobial drugs were significantly lower in the trial group compared to the control group(P<0.05).No statistical

关 键 词：多模式镇痛 腹腔镜袖状胃切除术 疼痛评分 术后疼痛管理 

分 类 号：R619[医药卫生—外科学] R982[医药卫生—临床医学]