多模式镇痛方案对腹腔镜胃肠术后疼痛的作用

Effect of Multimodal Analgesia on Pain after Laparoscopic Gastrointestinal Surgery

摘要:

〔摘 要〕 目的：探讨多模式镇痛方案对腹腔镜胃肠术后疼痛的作用。 方法：选取 2020 年 1 月至 2022 年 6 月在郑 州大学第一附属医院接受腹腔镜胃肠癌手术治疗的96例患者，按随机数字表法划分为常规组与多模式组，每组各48例。 常规组采用常规镇痛方案，多模式组采用多模式镇痛方案。比较两组患者术后 72 h 内静息态与活动状态下疼痛程度 评分、术后镇痛情况与术后 72 h 内活动情况，出院前统计两组患者术后恢复进程。 结果：多模式组患者术后各时间 点静息态下视觉模拟评分法（VAS）评分均低于常规组，差异具有统计学意义（P ＜ 0.05）；多模式组患者术后 24 h、 48 h、72 h 活动状态下 VAS 评分均低于常规组，差异具有统计学意义（P ＜ 0.05）；多模式组患者术后经静脉自控镇 痛（PCIA）使用时间、按压次数与舒芬太尼用量均少于常规组，差异具有统计学意义（P ＜ 0.05）；多模式组患者 术后 72 h 内总活动时长、总活动频次及总活动距离均多于常规组，差异具有统计学意义（P ＜ 0.05）；多模式组患 者术后首次床旁活动时间、排气与排便恢复时间、首次进流食时间及住院时间均短于常规组，差异具有统计学意义 （P ＜ 0.05）。 结论：多模式镇痛方案能够有效减轻患者术后疼痛程度，减少术后阿片类镇痛药物的应用剂量，从而 发挥促进患者术后恢复、提高术后镇痛安全性的作用。

Abstract:

〔Abstract〕 Objective To investigate the effect of multi-mode analgesia on pain after laparoscopic gastrointestinal surgery. Methods A total of 96 patients who received laparoscopic surgery for gastrointestinal cancer in the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2022 were selected and divided into conventional group and multi-mode group according to random number table, with 48 patients in each group. The conventional group and the multi-mode group were given the conventional analgesic scheme and the multi-mode analgesic scheme. The score of pain degree in resting state and active state, postoperative analgesia and activity within 72 h after surgery were compared between the two groups. The postoperative recovery progress of the two groups of patients was analyzed before discharge. Results The visual analogue scales (VAS) scores in the multi-mode group were lower than those in the conventional group at all time points after surgery, and the differences were statistically significant (P < 0.05). The VAS scores in multi-mode group were lower than those in conventional group at 24 h, 48 h and 72 h after operation, and the differences were statistically significant (P < 0.05). The use time, number of compressions and dosage of sufentanil for patient–controlled intravenous analgesia (PCIA) in multi-mode group were lower than those in conventional group, with statistical significance (P < 0.05). The total activity duration, frequency and distance of patients in the multi-mode group were higher than those in the conventional group within 72 h after surgery, and the differences were statistically significant (P < 0.05). The first time of bedside movement, the recovery time of exhaust and defecation, the first time of liquid intake and the length of hospital stay in the multi-mode group were shorter than those in the conventional group, and the differences were statistically significant (P < 0.05). Conclusion The multi-mode analgesic program can effectively reduce the degree of postoperative pain and reduce the applied dose of postoperative opioid analgesic drugs, so as to promote the postoperative recovery of patients and improve the safety of postoperative analgesia.