Department of Anesthesiology, the Second Hospital of Hebei Medical University, NO 215Heping West Road, Shijiazhuang, Hebei, 050000, China.
Sci Rep. 2024 Oct 25;14(1):25438. doi: 10.1038/s41598-024-75720-7.
Objective To evaluate the effectiveness of preemptive multimodal analgesiain elderly patients undergoing laparoscopic colorectal surgery. Methods A prospective randomized controlled study was conducted in the Department of Gastrointestinal Surgery of the Second Hospital of Hebei Medical University from January 2022 to December 2022. A total of 133 patients were included according to the criteria and randomly divided into preemptive analgesia (PRA) group (test group, 67patients) and postoperative analgesia (POA) group (control group, 66patients). Results The Visual Analog Scale (VAS)scores of PRA group 24 h, 48 h, and 72 h after operation were lower than those of POA group, and the difference was statistically significant, P < 0.001.The incidences of postoperative gastrointestinal dysfunction (POGD) and postoperative delirium (POD)in PRA group were 13.43% and 8.98%, respectively, which were significantly lower than those in POA group (31.82% and 24.24%), P < 0.05. The levels of IL-6 and IL-10 in PRA group after the operation were 17.54 ± 2.13 ng/L and 15.57 ± 1.71 ng/L respectively, which were lower than those in POA group (25.45 ± 2.95 ng/L and 23.45 ± 1.88 ng/L), P < 0.05. The level of acetylcholinesterase(AchE) was 56.34 ± 5.62 nmol/L in the POA group, which was significantly higher than that in the POA group (49.59 ± 5.52 nmol/L), P < 0.001. Conclusion Preemptive multimodal analgesia can reduce the incidence of POGD and POD in elderly patients undergoing laparoscopic gastrocolic surgery, improve the recovery process of postoperative gastrointestinal function, increase the concentrations of propionic acid and butyric acid in short chain fatty acids (SCFAs) and the number of beneficial intestinal bacteria.
目的 评价超前多模式镇痛对老年腹腔镜结直肠手术患者的有效性。
方法 河北医科大学第二医院胃肠外科于 2022 年 1 月至 2022 年 12 月进行了一项前瞻性随机对照研究。根据标准共纳入 133 例患者，并随机分为超前镇痛（PRA）组（试验组，67 例）和术后镇痛（POA）组（对照组，66 例）。
结果 PRA 组术后 24、48 和 72 h 的视觉模拟评分（VAS）均低于 POA 组，差异具有统计学意义，P < 0.001。PRA 组术后胃肠功能障碍（POGD）和术后谵妄（POD）的发生率分别为 13.43%和 8.98%，明显低于 POA 组（31.82%和 24.24%），P < 0.05。PRA 组术后白细胞介素-6（IL-6）和白细胞介素-10（IL-10）水平分别为 17.54 ± 2.13 ng/L 和 15.57 ± 1.71 ng/L，低于 POA 组（25.45 ± 2.95 ng/L 和 23.45 ± 1.88 ng/L），P < 0.05。POA 组乙酰胆碱酯酶（AchE）水平为 56.34 ± 5.62 nmol/L，明显高于 POA 组（49.59 ± 5.52 nmol/L），P < 0.001。
结论 超前多模式镇痛可降低老年腹腔镜胃肠手术患者 POGD 和 POD 的发生率，改善术后胃肠功能恢复过程，增加短链脂肪酸（SCFAs）中丙酸和丁酸的浓度及有益肠道细菌数量。
