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[多模式预防性镇痛在肝癌肝部分切除患者中的临床价值]

[Clinical values of multimodal preventive analgesia in patients with partial hepatectomy for liver cancer].

作者信息

Zhou H, Jia W D, Qiao X F, Liu F P, Chen L, Hu C L

机构信息

Department of Hepatic Surgery, Affiliated Provincial Hospital, Anhui Medical University, Hefei 230001, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2017 Feb 1;55(2):141-145. doi: 10.3760/cma.j.issn.0529-5815.2017.02.013.

Abstract

To investigate the clinical values of multimodal preventive analgesia in patients with partial hepatectomy for liver cancer. A perspective study was conducted to collect data of patients with liver cancer who underwent partial hepatectomy from March 2014 to March 2015.The 90 patients involved in the study were randomly divided into two groups as multimodal analgesia and control groups, and each group had 45 cases. In multimodal analgesia group, 40 mg parecoxib sodium was injected intravenously 30 minutes before anesthetic induction, and 0.375% ropivacaine 150 mg combined with dexamethasone 5 mg were applied to transversus abdominis plane block before closing abdomen.The patients in control group without above treatment. Patient controlled intravenous analgesia was used in all patients. Three days after surgery, 40 mg parecoxib sodium was injected intravenously, twice a day for all patients.Visual analogue scales (VAS) was used to evaluate postoperative pain, and postoperative adverse events were observed.The number of cases of postoperative ambulation (>6 h for every day), time of flatus and defecation, and duration of hospital stay were recorded in two groups.Pearson chi-square test was used to compare the rate or constituent ratio between two groups.Independent sample test or Mann-Whitney was used to analyzed the measurement data between two groups. There were no difference between two groups in aging, gender, weight, body mass index, ASA classification, blood loss volume, time of operation(all >0.05). The scores of VAS in multimodal analgesia group was significantly lower than that in control group(3.0±0.8 . 4.6±1.1, =7.814, <0.01 for day 1; 2.2±1.0 . 3.6±1.2, =5.825, <0.01 for day 2; 1.6±0.8 . 2.4±1.2, =3.894, <0.01 for day 3). The number of cases of postoperative ambulation(>6 h) in multimodal analgesia group was significantly more than that in control group (10 cases . 0 case, χ(2)=11.250, <0.01 for day 1; 21 cases . 5 cases, χ(2)=13.846, <0.01 for day 2; 28 cases . 17 cases, χ(2)=5.378, =0.020 for day 3). The time of flatus and defecation, and duration of hospital stay were significantly shorter than that in control group((30.2±7.3) hours . (36.4±7.0)hours, =4.115, <0.01 for flatus; (50.9±5.2)hours . (60.7±7.3)hours, =7.346, <0.01 for defecation; (6.2±0.8)days . (9.6±1.1)days, =16.615, <0.01 for hospital stay). Multimodal preventive analgesia effectively alleviate the postoperative pain, benefits early ambulation, improves recovery of gastrointestinal function, and shortens duration of hospital stay in patients with partial hepatectomy for liver cancer.

摘要

探讨多模式预防性镇痛在肝癌肝部分切除患者中的临床价值。进行一项前瞻性研究,收集2014年3月至2015年3月期间行肝部分切除术的肝癌患者的数据。参与研究的90例患者随机分为多模式镇痛组和对照组,每组45例。多模式镇痛组在麻醉诱导前30分钟静脉注射40mg帕瑞昔布钠,关腹前将0.375%罗哌卡因150mg与地塞米松5mg用于腹横肌平面阻滞。对照组患者不进行上述治疗。所有患者均采用患者自控静脉镇痛。术后3天,所有患者均静脉注射40mg帕瑞昔布钠,每日2次。采用视觉模拟评分法(VAS)评估术后疼痛,并观察术后不良事件。记录两组患者术后活动(每天>6小时)的例数、肠鸣音和排便时间以及住院时间。采用Pearson卡方检验比较两组之间的率或构成比。采用独立样本t检验或Mann-Whitney检验分析两组之间的计量资料。两组患者在年龄、性别、体重、体重指数、ASA分级、失血量、手术时间方面比较,差异均无统计学意义(均>0.05)。多模式镇痛组VAS评分显著低于对照组(术后第1天:3.0±0.8 vs. 4.6±1.1,t=7.814,P<0.01;术后第2天:2.2±1.0 vs. 3.6±1.2,t=5.825,P<0.01;术后第3天:1.6±0.8 vs. 2.4±1.2,t=3.894,P<0.01)。多模式镇痛组术后活动(>6小时)的例数显著多于对照组(术后第1天:10例 vs. 0例,χ²=11.250,P<0.01;术后第2天:21例 vs. 5例,χ²=13.846,P<0.01;术后第3天:28例 vs. 17例,χ²=5.378,P=0.020)。肠鸣音和排便时间以及住院时间均显著短于对照组(肠鸣音:(30.2±7.3)小时 vs. (36.4±7.0)小时,t=4.115,P<0.01;排便:(50.9±5.2)小时 vs. (60.7±7.3)小时,t=7.346,P<0.01;住院时间:(6.2±0.8)天 vs. (9.6±1.1)天,t=16.615,P<0.01)。多模式预防性镇痛可有效减轻肝癌肝部分切除患者的术后疼痛,有利于早期活动,促进胃肠功能恢复,缩短住院时间。

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