摘要
目的探讨加速康复外科(ERAS)模式下不同镇痛方法对开腹子宫肌瘤剔除术患者术后康复的影响。方法选取2019年3~10月在甘肃省妇幼保健院行ERAS模式子宫肌瘤剔除术患者50例,采用随机数字表法将其分为M组和C组,每组25例。M组采用多模式镇痛,C组采用静脉自控镇痛。M组于术前2 h口服对乙酰氨基酚500 mg、布洛芬600 mg。手术结束关腹前0.25%罗哌卡因20 mL切口浸润麻醉,术后返回病房后口服曲马多片100 mg,3次/d,连续3 d。C组于术后行静脉自控镇痛,持续48 h。记录两组术后3 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)视觉模拟评分(VAS)。记录两组术后肛门排气时间、平均住院日及平均住院费用。记录两组术后皮肤瘙痒、恶心呕吐、尿潴留、SpO2<94%的发生率及补救镇痛率。于术前2 h(T0)、T4时分别抽取静脉血3 mL,采用酶联免疫法检测白细胞介素6(IL-6)和肿瘤坏死因子-α(TNF-α)的浓度。结果不同时间点VAS评分差异有统计学意义(P<0.05);组间VAS评分差异有统计学意义(P<0.05);不同时间点与两组之间存在交互作用(P<0.05)。M组T1时VAS评分低于C组(P<0.05)。与T1比较,M组T2~T4时VAS评分增加(P<0.05),C组在T2~T4时VAS评分降低(P<0.05),与T2比较,M组在T4时VAS评分增加(P<0.05)。M组肛门排气时间早于C组(P<0.05),两组患者住院日及住院费用比较差异无统计学意义(P>0.05)。M组皮肤瘙痒、恶心呕吐及补救镇痛者少于C组比较降低(P<0.05),两组尿潴留、SpO2<94%的发生人数比较差异无统计学意义(P>0.05)。与T0时比较,两组在T4时IL-6和TNF-α浓度升高(P<0.05),与C组比较,M组在T4时IL-6和TNF-α浓度降低(P<0.01)。结论在ERAS模式下,妇科开腹手术围术期采用非甾体类抗炎药联合中枢性镇痛药与局部麻醉药相结合的多模式镇痛模式能有效减轻患者疼痛及炎性反应,促进患者早期康复。
Objective To evaluate the effect of different analgesic methods on postoperative rehabilitation of patients undergoing transabdominal myomectomy in enhanced recovery after surgery(ERAS)mode.Methods A total of 50 patients with uterine fibroids,scheduled transabdominal myomectomy in Gansu Provincial Maternity and Child Care Hospital from March to October 2019 were divided into group M and group C by random number table method,with 25 cases in each group.Group M were treated with acetaminophen 500 mg and Ibuprofen 600 mg oral administration in preoperative,0.25%Ropivacaine 20 mL infiltration at incision before the end of the operation and taken Tramadol 100 mg postoperative three times a day for three days.Group C were treated with intravenous patient controlled analgesia for 48 h.The visual analogue score(VAS)of the two groups were recorded at 3 h(T1),6 h(T2),12 h(T3)and 24 h(T4)after operationin.The time of anal exhaust in postoperative,hospital stay,hospitalization cost and the rate of pruritus,nausea and vomiting,urinary retention,SpO2<94%and rescue analgesia were recorded in the two groups.A total of 3 mL of venous blood were taken at 2 h(T0)and T4before surgery and interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immune assay.Results There was difference in VAS score between different time points(P<0.05),the difference of VAS scores between groups was statistically significant(P<0.05).there was interaction between different time points and the two groups(P<0.05),The VAS score of group M at T1was lower than that of group C(P<0.05).Compared with T1,the VAS score of group M increased at T2-T4(P<0.05),while VAS score of group C decreased at T2-T4(P<0.05).Compared with T2,the VAS score of group M increased at T4(P<0.05).The anal exhaust time of group M was earlier than that of group C(P<0.05).There was no significant difference between two groups in hospital stay and hospitalization cost(P>0.05).The number of patients with skin pruritus,nausea and vomiting and rescueanalgesia in group M were less than those in group C(P<0.05).There was no significant difference in the number of urinary retention and Sp O2<94%between the two groups(P>0.05).Compared with T0,the concentrations of IL-6 and TNF-αin the two groups were increased at T4(P<0.05).Compared with group C,the concentrations of IL-6 and TNF-αin group M were decreased at T4(P<0.01).Conclusion Under the ERAS mode,the multi-mode analgesic mode of nsaids combined with central analgesics and local anesthetics in the perioperative period of gynecological open surgery can effectively reduce the pain and inflammatory response of patients and promote the early rehabilitation of patients.
作者
韩旭东
杜丽芳
平春枝
张小兰
HAN Xudong;DU Lifang;PING Chunzhi;ZHANG Xiaolan(Department of Anesthesiology,Gansu Provincial Maternity and Child Care Hospital,Gansu Province,Lanzhou 730050,China)
出处
《中国医药导报》
CAS
2020年第10期109-112,共4页
China Medical Herald
基金
甘肃省卫生行业科研计划项目(GSWSKY-2014-18)
甘肃省兰州市人才创新创业项目(2016-RC-48)。
关键词
加速康复外科
镇痛
子宫肌瘤剔除术
术后康复
Enhanced recovery aftersurgery
Analgesia
Myomectomy
Postoperativerehabilitation
作者简介
韩旭东(1979.12-),男,硕士,副主任医师,研究方向:麻醉与围术期镇痛。
