Tsui S L, Law S, Fok M, Lo J R, Ho E, Yang J, Wong J
Department of Anesthesiology, University of Hong Kong, Queen Mary Hospital.
Am J Surg. 1997 Jun;173(6):472-8. doi: 10.1016/s0002-9610(97)00014-7.
To study the influence of postoperative analgesia on morbidity and mortality after esophagectomy.
The outcomes of 578 patients who underwent one-stage resection between 1986 and 1995 were analyzed. Patients who received either epidural morphine, patient-controlled analgesia, or continuous intravenous morphine infusion supervised by an anesthesiology-based acute pain service (group APS, n = 299) were compared with those for whom conventional intramuscular meperidine injections were used (group CON, n = 279).
For patients who underwent transthoracic esophagectomy, group APS (n = 226) had a lower incidence of pulmonary complications (13% versus 25%, P = 0.002), cardiovascular complications (21% versus 43%, P < 0.001), and hospital mortality (8% versus 14%, P = 0.038) when compared with group CON (n = 189). No similar difference was demonstrated in patients who underwent esophagectomy without thoracotomy. The hospital stay (days) was shorter in group APS than in group CON for both transthoracic esophagectomy (22 +/- 20 versus 30 +/- 37, P = 0.005) and nontransthoracic esophagectomy patients (19 +/- 13 versus 25 +/- 21, P = 0.029).
Adequate postoperative analgesia is associated with lower cardiopulmonary complications, lower mortality and reduced cost in patients undergoing transthoracic esophagectomy.
研究术后镇痛对食管切除术后发病率和死亡率的影响。
分析了1986年至1995年间接受一期切除的578例患者的结局。将接受硬膜外吗啡、患者自控镇痛或由麻醉科急性疼痛服务团队监督的持续静脉吗啡输注的患者（APS组，n = 299）与使用传统肌内注射哌替啶的患者（CON组，n = 279）进行比较。
对于接受经胸食管切除术的患者，与CON组（n = 189）相比，APS组（n = 226）的肺部并发症发生率较低（13%对25%，P = 0.002）、心血管并发症发生率较低（21%对43%，P < 0.001）以及医院死亡率较低（8%对14%，P = 0.038）。在未进行开胸的食管切除患者中未显示出类似差异。对于经胸食管切除术患者（22±20对30±37，P = 0.005）和非经胸食管切除术患者（19±13对25±21，P = 0.029），APS组的住院天数均短于CON组。
充分的术后镇痛与经胸食管切除患者较低的心肺并发症、较低的死亡率和降低的费用相关。
