多模式镇痛在腹腔镜胃癌根治术中的应用
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摘要
目的探讨多模式镇痛在腹腔镜胃癌根治术中的应用效果。方法选取沙坪坝区人民医院2017年1-12月收治的胃癌患者100例,采用随机数字表法分为观察组和对照组,每组50例。观察组进行腹腔镜胃癌根治手术后使用自控静脉镇痛(PCIA)泵注盐酸右美托咪定和盐酸舒芬太尼并联合切口周围浸润盐酸罗哌卡因进行多模式镇痛;对照组进行腹腔镜手术后使用PCIA泵注盐酸舒芬太尼和托烷司琼镇痛。准确记录并比较两组患者在手术后12、24、36、48h的视觉模拟疼痛评分(VAS)、免疫功能以及两组患者的不良反应和镇痛的满意度。结果观察组在手术后12、24、36、48h的VAS评分明显低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。观察组术后满意度(94.0%)明显高于对照组(74.0%),差异有统计学意义(P<0.05)。结论多模式镇痛在腹腔镜胃癌根治术中可明显改善术后镇痛效果和提高患者满意度,并且有效减少了术后不良反应的发生风险,可在临床推广使用。
Objective To explore the effect of multi-mode analgesia in gastric cancer by laparoscope.Methods A total of 100 patients with gastric cancer from January 2017 to December 2017 were randomly divided into observation group and control group with 50 cases in each group.In the observation group,dexmedetomidine and sufentanil combined with ropivacaine were used for multi-mode analgesia,while in the control group,sufentanil was used for analgesia.Visual analogue pain score(VAS)after the operation were compared in the two groups at the point of 12 h(T1),24 h(T2),36 h(T3)and 48 h(T4).Serum CD4+and CD8+were assayed respectively before and after surgery.Adverse reactions and patient satisfaction with postoperative analgesia in two groups after surgery were also compared.Results The VAS scores in the observation group were significantly lower than those in the control group at T1,T2,T3 and T4 after operation(P<0.05).The rate of adverse reactions in the observation group was significantly lower than control group(P<0.05).The satisfaction degree of the observation group(94.0%)was significantly higher than that of the control group(74.0%)(P<0.05).Conclusion Multi-mode analgesia in laparoscopic radical gastrectomy for gastric cancer could significantly improve postoperative analgesia effect and patient satisfaction,and effectively reduce the risk of postoperative adverse reactions,which could be popularized in clinic.
Objective To explore the effect of multi-mode analgesia in gastric cancer by laparoscope.Methods A total of 100 patients with gastric cancer from January 2017 to December 2017 were randomly divided into observation group and control group with 50 cases in each group.In the observation group,dexmedetomidine and sufentanil combined with ropivacaine were used for multi-mode analgesia,while in the control group,sufentanil was used for analgesia.Visual analogue pain score(VAS)after the operation were compared in the two groups at the point of 12 h(T1),24 h(T2),36 h(T3)and 48 h(T4).Serum CD4+and CD8+were assayed respectively before and after surgery.Adverse reactions and patient satisfaction with postoperative analgesia in two groups after surgery were also compared.Results The VAS scores in the observation group were significantly lower than those in the control group at T1,T2,T3 and T4 after operation(P<0.05).The rate of adverse reactions in the observation group was significantly lower than control group(P<0.05).The satisfaction degree of the observation group(94.0%)was significantly higher than that of the control group(74.0%)(P<0.05).Conclusion Multi-mode analgesia in laparoscopic radical gastrectomy for gastric cancer could significantly improve postoperative analgesia effect and patient satisfaction,and effectively reduce the risk of postoperative adverse reactions,which could be popularized in clinic.
引文
[1]高宇.氟比洛芬酯的多模式镇痛对胃癌根治术患者细胞免疫功能的影响[J].齐齐哈尔医学院学报,2016,37(7):906-907.
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[6]周桥灵,徐枫,李露君,等.不同剂量右美托咪定复合罗哌卡因腹横肌平面阻滞用于腹腔镜结肠癌手术镇痛[J].实用医学杂志,2016,32(24):4108-4110.
[7]吴江东,蒋宗滨.术后镇痛的趋势---多模式镇痛[J].实用疼痛学杂志,2013,9(1):63-67.
[8]AKBARI E.The role of cyclo-oxygenase inhibitors in attenuating opioid-induced tolerance,hyperalgesia,and dependence[J].Med Hypotheses,2012,78(1):102-106.
[9]洪彬源,刘洪珍,潘晓梅,等.多模式的镇痛方法对结肠癌根治术患者的免疫功能的影响[J].免疫学杂志,2016,32(4):351-355.
[10]TABUSE H,KURIYAMA T,SHINGAKI N,et al.P3-7-56Relief of severe cancer pain by subarachnoid analgesia in a young patient with peritonitis carcinomatosa of gastric cancer,allowing him to share the birth of his first daughter[J].Ann Oncol,2015,26(suppl 7):vii146.
[11]尚宇,龙晓宏,高光洁,等.右美托咪定辅助舒芬太尼用于胃癌术后静脉镇痛的剂量探讨[J].临床麻醉学杂志,2013,29(3):247-250.
[12]张艳阁.羟考酮联合帕瑞昔布钠用于胃癌根治术后镇痛的临床效果[J].中国现代医生,2016,54(22):108-110.
[13]周文,余云明,高德胜,等.超声引导下腹直肌鞘阻滞复合静脉自控镇痛对胃癌术后镇痛的疗效分析[J].实用癌症杂志,2017,32(1):97-99.
[14]张学俊,任春光,张宗旺.联合应用右美托咪定和舒芬太尼对腹腔镜子宫全切患者术后镇痛的影响[J].国际麻醉学与复苏杂志,2015,36(8):691-695.
[2]SCHNABEL A,MEYER-FRIEEM C H,REICHL S U,et al.Is intraoperative dexmedetomidine a new option for postoperative pain treatment?a meta-analysis of randomized controlled trials[J].Pain,2013,154(7):1140-1149.
[3]陆海波,陈默,司波,等.多模式镇痛对肺癌根治术患者术后疼痛和免疫功能的影响[J].中国临床研究,2015,28(11):1493-1495.
[4]SHIN S,KIM H I,KIM N Y,et al.Effect of postoperative analgesia technique on the prognosis of gastric cancer:a retrospective analysis[J].Oncotarget,2017,8(61):104594-104604.(下转第1680页)
[5]SHIN H J,OH A Y,BAIK J S,et al.Ultrasound-guided oblique subcostal transversus abdominis plane block for analgesia after laparoscopic cholecystectomy:a randomized,controlled,observer-blinded study[J].Minerva Anestesiol,2014,80(2):185-193.
[6]周桥灵,徐枫,李露君,等.不同剂量右美托咪定复合罗哌卡因腹横肌平面阻滞用于腹腔镜结肠癌手术镇痛[J].实用医学杂志,2016,32(24):4108-4110.
[7]吴江东,蒋宗滨.术后镇痛的趋势---多模式镇痛[J].实用疼痛学杂志,2013,9(1):63-67.
[8]AKBARI E.The role of cyclo-oxygenase inhibitors in attenuating opioid-induced tolerance,hyperalgesia,and dependence[J].Med Hypotheses,2012,78(1):102-106.
[9]洪彬源,刘洪珍,潘晓梅,等.多模式的镇痛方法对结肠癌根治术患者的免疫功能的影响[J].免疫学杂志,2016,32(4):351-355.
[10]TABUSE H,KURIYAMA T,SHINGAKI N,et al.P3-7-56Relief of severe cancer pain by subarachnoid analgesia in a young patient with peritonitis carcinomatosa of gastric cancer,allowing him to share the birth of his first daughter[J].Ann Oncol,2015,26(suppl 7):vii146.
[11]尚宇,龙晓宏,高光洁,等.右美托咪定辅助舒芬太尼用于胃癌术后静脉镇痛的剂量探讨[J].临床麻醉学杂志,2013,29(3):247-250.
[12]张艳阁.羟考酮联合帕瑞昔布钠用于胃癌根治术后镇痛的临床效果[J].中国现代医生,2016,54(22):108-110.
[13]周文,余云明,高德胜,等.超声引导下腹直肌鞘阻滞复合静脉自控镇痛对胃癌术后镇痛的疗效分析[J].实用癌症杂志,2017,32(1):97-99.
[14]张学俊,任春光,张宗旺.联合应用右美托咪定和舒芬太尼对腹腔镜子宫全切患者术后镇痛的影响[J].国际麻醉学与复苏杂志,2015,36(8):691-695.