摘要
目的评价全程多模式镇痛对行泌尿系统恶性肿瘤根治术的老年患者术后疼痛和快速康复的影响。方法回顾性选择2022年1至6月在北京大学第三医院接受全身麻醉下择期泌尿系统恶性肿瘤根治术的132例老年患者(年龄≥65岁)。根据围手术期镇痛方案分为以下3组:C组[54例,男45例,女9例,年龄72(68,76)岁]:应用切口周围局部浸润麻醉(LAWI)+术后非甾体抗炎药(NSAIDs);P组[36例,男26例,女10例,年龄70(67,72)岁]:应用LAWI+患者静脉自控镇痛(PCIA)+NSAIDs;M组[42例,男30例,女12例,年龄70(68,73)岁]:接受全程多模式镇痛,术前实施外周神经阻滞(PNB)+术后PCIA+NSAIDs。收集并比较3组患者术后第1、2天静息疼痛数字分级评分(NRS)、术后补救镇痛需求率、助眠药物需求率及恶心呕吐发生率;术后恢复情况,包括术后24 h实验室指标、排便时间、引流管拔除时间、出院时日常生活能力(ADL)评分、术后并发症发生率以及住院时间。结果M组患者术后第1、2天的静息NRS[M(Q_(1),Q_(3))]分别为2(1,3)、1(0,2)分,均低于C组的4(3,5)、2(1,4)分及P组的3(2,4)、2(1,3)分(均P<0.001);M组患者术后第1、2天静息NRS≥4分发生率为23.8%(10/42)、11.9%(5/42),均低于C组的51.9%(28/54)、35.2%(19/54)及P组的33.3%(14/36)、16.7%(7/36)(均P<0.05);M组患者术后48 h内补救镇痛需求率、助眠药物需求率、并发症发生率、术后住院天数分别为47.6%(20/42)、9.5%(4/42)、21.4%(9/42)、5(4,6)d,均低于C组的72.2%(39/54)、29.6%(16/54)、46.3%(25/54)、6(5,9)d及P组的66.7%(24/36)、27.8%(10/36)、27.8%(10/36)、6(5,7)d(均P<0.05)。3组患者术后恶心呕吐发生率、实验室指标、排便时间、引流管拔除时间、出院ADL评分及总住院天数差异均无统计学意义(均P>0.05)。结论全程多模式镇痛可改善泌尿系统恶性肿瘤根治手术老年患者术后48 h内疼痛情况,降低术后并发症,缩短术后住院时间,加速患者康复。
Objective To evaluate the effectiveness of whole-course multimodal analgesia on postoperative pain and rapid recovery in elderly patients undergoing radical resection of urological tumors.Methods The 132 geriatric patients(aged≥65 years)with urological tumors undergone laparoscopic surgery in Peking University Third Hospital from January to June 2022 were analyzed retrospectively.Patients were divided into three groups based on the perioperative analgesia protocol.Group C[n=54,45 males and 9 females,aged 72(68,76)years]:patients were treated with local anesthetic wounds infiltration(LAWI)and non-steroidal anti-inflammatory drugs(NSAIDs).Group P[n=36,26 males and 10 females,aged 70(67,72)years]:patients received patient-controlled intravenous analgesia(PCIA)on the basis of LAWI and NSAIDs.Group M[n=42,30 males and 12 females,aged 70(68,73)years]:patients received whole-course multimodal analgesia,including peripheral nerve block(PNB)preoperatively and PCIA+NSAIDs for postoperative analgesia.The postoperative resting pain(numerical rating scale,NRS)on postoperative day 1 and 2,the rate of demand for analgesic rescue and sleep aid medication,the incidence of postoperative nausea and vomiting within 48 hours after surgery were collected and analyzed.Postoperative recovery conditions included the laboratory indicators within 24 hours after surgery,the defecation time,the drainage tube removal time,the activities of daily living(ADL)score at discharge,the postoperative complications and the length of hospital stay.Results The resting NRS[M(Q_(1),Q_(3))]on the 1st and 2nd day postoperatively for patients in group M were 2(1,3)and 1(0,2)respectively.In contrast,patients in group C had NRS of 4(3,5)and 2(1,4),while those in group P had scores of 3(2,4)and 2(1,3).Compared with group C and group P,the resting NRS of patients in group M was significantly decreased(all P<0.001).The incidence of resting NRS≥4 in group M on the 1st and 2nd day postoperatively were 23.8%(10/42)and 11.9%(5/42)respectively,which were lower than those of 51.9%(28/54),35.2%(19/54)in group C and 33.3%(14/36),16.7%(7/36)in group P(all P<0.05).The demand rate for analgesic rescue and sleep aid medication within 48 hours after surgery,the incidence of postoperative complications and the postoperative hospital stay were 47.6%(20/42),9.5%(4/42),21.4%(9/42),and 5(4,6)d in group M,which were lower than those of 72.2%(39/54),29.6%(16/54),46.3%(25/54),6(5,9)in group C,and 66.7%(24/36),27.8%(10/36),27.8%(10/36),6(5,7)in group P(all P<0.05).There were no statistically significant differences in the incidence of postoperative nausea and vomiting,the laboratory indicators within 24 hours after surgery,the defecation time,the drainage tube removal time,the ADL score and the length of hospital stay among three groups(all P>0.05).Conclusion For elderly patients with urological tumors undergoing radical surgery,whole-course multimodal analgesia can improve postoperative pain within 48 hours,reduce postoperative complications,shorten postoperative hospital stay,and accelerate patient recovery.
作者
刘慧丽
宋亚男
王晓晓
李民
Liu Huili;Song Ya′nan;Wang Xiaoxiao;Li Min(Department of Anesthesiology,Peking University Third Hospital,Beijing 100191,China;Clinical Epidemiology Research Center,Peking University Third Hospital,Beijing 100191,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第41期3245-3251,共7页
National Medical Journal of China
关键词
老年人
泌尿系统肿瘤
多模式镇痛
加速康复外科
Aged
Urological tumors
Multimodal analgesia
Enhanced recovery after surgery
作者简介
通信作者:李民,Email:liminanesth@bjmu.edu.cn
