肿瘤手术后使用患者自控硬膜外镇痛改善恢复参数。一项前瞻性、随机单中心研究。
Improvement of recovery parameters using patient-controlled epidural analgesia after oncological surgery. A prospective, randomized single center study.
作者信息
Zgâia Armeana Olimpia, Lisencu Cosmin Ioan, Rogobete Alexandru, Vlad Cătălin, Achimaş-Cadariu Patriciu, Lazăr Gabriel, Muntean Maximilian, Ignat Florin, Ormindean Vlad, Irimie Alexandru
机构信息
Department of Surgery, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania.
Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
出版信息
Rom J Anaesth Intensive Care. 2017 Apr;24(1):29-36. doi: 10.21454/rjaic.7518.241.zga.
PURPOSE
The aim of this study was to compare patient-controlled epidural analgesia (PCEA) versus conventional opioid intravenous (IV) infusion after gastrointestinal cancer surgery regarding several post-surgery parameters of recovery.
METHODS
One hundred and one patients were prospectively randomized to receive either thoracic/lumbar PCEA (PCEA group) or the standard analgesia technique used in our hospital, conventional IV infusion of morphine (IVMO group) after gastrointestinal cancer surgery. Pain intensity, time of mobilization and bowel function recovery were analyzed post-surgery. We also evaluated postoperative complications and length of Postoperative-Intermediate Intensive Care Unit (PI-ICU) stay and hospital stay.
RESULTS
Pain intensity was significantly less in the PCEA group in comparison with the IVMO Group at awakening 2, 8, 24, 30 and 48 hours after surgery (p <0.001, p <0.001, p <0.001, p = 0.043, p = 0.036, and p = 0.029, respectively). The latency to bedside mobilization, walking, first postoperative flatus and apparition of first stool were significantly faster (1.74 versus 2.26 days, 3.06 versus 3.78 days, 2.1 versus 3.14 days and 3.73 versus 5.28 days, respectively) in the PCEA group than in the IVMO group (p <0.001, p <0.001, p <0.001, and p <0.001, respectively). The incidence of nausea/vomiting was significantly lower in the PCEA group in comparison with the IVMO group (p = 0.001). Surgical-associated complications were significantly lower in the IVMO Group than in the PCEA group (p = 0.023). Length of PI-ICU stay was similar in the two groups but length of hospital stay was significantly shorter in PCEA group (4 versus 5 days p = 0.2849, 9 versus 12 days; p <0.001).
CONCLUSIONS
PCEA provides better postoperative pain control, improves postoperative recovery after gastrointestinal cancer surgery compared with conventional intravenous morphine infusion. Therefore, it is more acceptable than conventional pain management.
目的
本研究旨在比较胃肠癌手术后患者自控硬膜外镇痛（PCEA）与传统阿片类药物静脉输注（IV）在术后恢复的几个参数方面的差异。
方法
101例患者前瞻性随机分为接受胸段/腰段PCEA（PCEA组）或我院使用的标准镇痛技术，即胃肠癌手术后传统静脉输注吗啡（IVMO组）。术后分析疼痛强度、活动时间和肠功能恢复情况。我们还评估了术后并发症以及术后中级重症监护病房（PI-ICU）住院时间和住院总时长。
结果
与IVMO组相比，PCEA组在术后2、8、24、30和48小时苏醒时的疼痛强度显著更低（分别为p<0.001、p<0.001、p<0.001、p = 0.043、p = 0.036和p = 0.029）。PCEA组在床边活动、行走、首次术后排气和首次排便的延迟时间显著更快（分别为1.74天对2.26天、3.06天对3.78天、2.1天对3.14天和3.73天对5.28天），优于IVMO组（分别为p<0.001、p<0.001、p<0.001和p<0.001）。与IVMO组相比，PCEA组恶心/呕吐的发生率显著更低（p = 0.001）。手术相关并发症在IVMO组显著低于PCEA组（p = 0.023）。两组PI-ICU住院时间相似，但PCEA组住院总时长显著更短（4天对5天，p = 0.2849；9天对12天；p<0.001）。
结论
与传统静脉输注吗啡相比，PCEA能提供更好的术后疼痛控制，改善胃肠癌手术后的恢复情况。因此，它比传统疼痛管理更易被接受。
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