加速康复外科指导下的多模式镇痛对开腹结肠癌患者术后恢复的影响

doi:10.6040/j.issn.1671-7554.0.2019.286

摘要/Abstract

摘要： 目的探讨在加速康复外科(ERAS)理念指导下,应用多模式镇痛(MMA)对接受开腹结肠癌手术的患者术后恢复的影响。方法回顾性分析2018年7月~ 11月,南京大学医学院附属金陵医院普通外科62例行开腹结肠癌根治术的患者,其中多模式镇痛(MMA)组有31名患者,病人自控静脉镇痛(PCIA)组有31例患者。观察并比较两组患者术后的VAS评分、恢复情况及术后30 d并发症的发生率。结果 MMA组患者对比PCIA组患者术后首次排气时间［(28.1±15.2)h vs(50.2±26.2)h,t=4.059,P<0.001］、首次排便时间［(38.9±19.4)h vs(62.6±25.8)h,t=4.085,P<0.001］、首次下床活动时间［(17.6±9.3)h vs(30.0±13.4)h,t=4.259,<0.001］、首次进食半流质时间［(21.3±9.5)h vs(60.6±27.0)h,t=7.652,P<0.001］及术后住院天数［(6.8±4.7)d vs(8.8±1.9)d,t=2.150,P=0.036］指标上均显示出优势;MMA组术后镇痛效果优于PCIA组;两组患者术后30 d内并发症的发生率差异无统计学意义。结论 ERAS理念的指导下,开腹结肠癌患者术后应用MMA有利于术后的快速康复,镇痛效果好,且并未增加术后并发症的风险,是安全有效的。

关键词: 多模式镇痛, 结肠癌, 加速康复外科, 术后恢复

Abstract: Objective To investigate the effects of multimodal analgesia(MMA)on postoperative recovery in patients undergoing open colon cancer surgery under the guidance of enhanced recovery after surgery(ERAS). Methods The clinical data of 62 patients from Jinling Hospital, Medical School of Nanjing University who underwent open colon cancer surgery during Jul. and Nov. 2018 were retrospective analyzed. The patients were divided into two groups: multimodal analgesia group(MMA group, n=31)and the patient-controlled intravenous analgesia group(PCIA group, n=31). The visual analogue score(VAS), recovery and incidence of complications 30 days after surgery were observed and compared between the two groups. Results Compared with the PCIA group, the MMA group needed shorter time for the first flatus ［(28.1±15.2)h vs(50.2±26.2)h,t=4.059,P<0.001］, first defecation［(38.9±19.4)h vs(62.6±25.8 h,t=4.085,P<0.001］, first off-bed activity［(17.6±9.3)h vs(30.0±13.4)h,t=4.259,<0.001］, first semi-liquid meal［(21.3±9.5)h vs(60.6±27.0)h,t=7.652,P<0.001］, and shorter postoperative stay ［(6.8±4.7)d vs(8.8±1.9)d, 山东大学学报 (医学版)57卷9期 -周嘉晖,等.加速康复外科指导下的多模式镇痛对开腹结肠癌患者术后恢复的影响 \=-t=2.150,P=0.036］. The MMA group had better analgesia effect than the PCIA group, but there was no significant difference in the incidence of complications between the two groups 30 days after surgery. Conclusion Under the guidance of ERAS, multimodal analgesia can help the patients recovery. It is safe and effective, without increasing the risk of postoperative complications.

Key words: Multimodal analgesia, Colon cancer, Enhanced recovery after surgery, Postoperative recovery

中图分类号:

R619

周嘉晖,王刚,刘江,赵健,王海锋,江志伟. 加速康复外科指导下的多模式镇痛对开腹结肠癌患者术后恢复的影响[J]. 山东大学学报 (医学版), 2019, 57(9): 38-42.

ZHOU Jiahui, WANG Gang, LIU Jiang, ZHAO Jian, WANG Haifeng, JIANG Zhiwei. Effects of multimodal analgesia under the guidance of enhanced recovery after open surgery on postoperative recovery of patients with colon cancer[J]. Journal of Shandong University (Health Sciences), 2019, 57(9): 38-42.

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