悬雍垂腭咽成形术术后多模式镇痛策略的研究进展
Research Progress on Multimodal Analgesia Strategies after Uvulopalatopharyngoplasty
摘要: 悬雍垂腭咽成形术(Uvulopalatopharyngoplasty, UPPP)是治疗阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea Hypopnea Syndrome, OSAHS)的重要术式，但术后中重度咽痛发生率高(>60%)，且传统单模式镇痛(如单纯阿片类)存在依赖风险及不良反应。近年来，多模式镇痛策略凭借其多靶点协同作用机制，在提升UPPP术后镇痛安全性并加速患者康复方面显示出显著的临床价值。文章系统综述了UPPP术后多模式镇痛策略的研究进展，重点分析了药物组合与非药物技术的协同作用，以期为阻塞性睡眠呼吸暂停(Obstructive Sleep Apnea, OSA)患者疼痛管理策略的优化提供理论依据。
Abstract: Uvulopalatopharyngoplasty (UPPP) is an important surgical procedure for treating obstructive sleep apnea hypopnea syndrome (OSAHS), but it is associated with a high incidence of moderate to severe sore throat postoperatively (>60%). Additionally, traditional single-modality analgesia (such as opioid-only regimens) carries risks of dependence and adverse effects. In recent years, multimodal analgesia strategies have demonstrated significant clinical value in enhancing postoperative analgesic safety and accelerating patient recovery following UPPP, owing to their multi-target synergistic mechanisms. This paper systematically reviews the research progress of multimodal analgesia strategies after UPPP surgery, focusing on the synergistic effects of drug combinations and non-pharmacological techniques, with the aim of providing a theoretical basis for optimizing pain management strategies for patients with obstructive sleep apnea (OSA).
文章引用：柳贵杰, 汤树海. 悬雍垂腭咽成形术术后多模式镇痛策略的研究进展[J]. 临床医学进展, 2026, 16(2): 932-938. https://doi.org/10.12677/acm.2026.162470

参考文献

[1] 杨森, 黄定强, 赵春蓉, 等. 悬雍垂腭咽成形术在OSAHS治疗中的应用及患者血氧饱和度、鼾声指数与并发症发生情况[J]. 中国老年学杂志, 2019, 39(14): 3458-3461.
[2] Stuck, B.A., Ravesloot, M.J.L., Eschenhagen, T., de Vet, H.C.W. and Sommer, J.U. (2018) Uvulopalatopharyngoplasty with or without Tonsillectomy in the Treatment of Adult Obstructive Sleep Apnea—A Systematic Review. Sleep Medicine, 50, 152-165. [Google Scholar] [CrossRef] [PubMed]
[3] Huang, F., Wang, M., Chen, H., Cheng, N., Wang, Y., Wu, D., et al. (2021) Analgesia and Patient Comfort after Enhanced Recovery after Surgery in Uvulopalatopharyngoplasty: A Randomised Controlled Pilot Study. BMC Anesthesiology, 21, Article No. 237. [Google Scholar] [CrossRef] [PubMed]
[4] 李玉杰, 韩伟, 黄炜, 等. 加速康复外科在44例悬雍垂腭咽成形术中的应用[J]. 山东大学学报(医学版), 2020, 58(11): 92-97+102.
[5] Bamgbade, O.A., Oluwole, O. and Khaw, R.R. (2017) Perioperative Analgesia for Fast-Track Laparoscopic Bariatric Surgery. Obesity Surgery, 27, 1828-1834. [Google Scholar] [CrossRef] [PubMed]
[6] Tierney, W.S., Gabarain, G. and Kominsky, A.H. (2017) Healthcare Usage after Uvulopalatopharyngoplasty-Impact of Analgesic Regimen. American Journal of Otolaryngology, 38, 193-197. [Google Scholar] [CrossRef] [PubMed]
[7] Deng, S., Chen, L., Song, X., Guo, L., Zhao, F., Liu, J., et al. (2023) Analgesic Effect of Intraoperative Intravenous S(+)-Ketamine during Total Knee Arthroplasty Surgery: Study Protocol for a Randomized Controlled Clinical Trial. JMIR Research Protocols, 12, e53063. [Google Scholar] [CrossRef] [PubMed]
[8] Ayatollahi, V., Dehghanpour Farashah, S., Behdad, S., Vaziribozorg, S. and Rabbani Anari, M. (2017) Effect of Intravenous Vitamin C on Postoperative Pain in Uvulopalatopharyngoplasty with Tonsillectomy. Clinical Otolaryngology, 42, 139-143. [Google Scholar] [CrossRef] [PubMed]
[9] Mulier, J.P. (2016) Perioperative Opioids Aggravate Obstructive Breathing in Sleep Apnea Syndrome: Mechanisms and Alternative Anesthesia Strategies. Current Opinion in Anaesthesiology, 29, 129-133. [Google Scholar] [CrossRef] [PubMed]
[10] 张静, 夏瑜, 陆希, 等. 加速康复外科模式下妇科良性疾病腹腔镜手术多模式镇痛与传统镇痛方案效果比较研究[J]. 中国实用妇科与产科杂志, 2024, 40(6): 657-660.
[11] 赵晨, 王洪明, 马沂, 等. UPPP术后疼痛连续变化规律及应用氟比洛芬酯镇痛的临床研究[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(7): 504-509.
[12] Hsieh, C., Sun, C., Lin, C. and Chou, Y. (2024) Comparative Analysis of Ketorolac and Parecoxib for Postoperative Pain Management in Uvulopalatopharyngoplasty. Journal of Clinical Medicine, 13, Article 4422. [Google Scholar] [CrossRef] [PubMed]
[13] Xie, G., Chu, Q. and Liu, C. (2013) Application of Parecoxib in Post-Uvulopalatopharyngoplasty Analgesia. Journal of International Medical Research, 41, 1699-1704. [Google Scholar] [CrossRef] [PubMed]
[14] Chen, J.K., Niddam, D.M., Tung, T. and Li, L.P. (2021) Topical Triamcinolone on “Sweet Spots” to Block Dynamic Pain after Tonsillectomy and Uvulo-Palato-Pharyngo-Plasty. Annals of Otology, Rhinology & Laryngology, 130, 382-388. [Google Scholar] [CrossRef] [PubMed]
[15] Xu, C., Wang, X., Wang, M., Wang, D., Kong, S., Zhou, Q., et al. (2025) Implication of Preoperative Intravenous Dexamethasone on Pain and Nausea in Late-Stage Elderly Total Knee Arthroplasty Patients: A Randomized Double-Blind Trial. The Journal of Arthroplasty, 40, 3176-3185. [Google Scholar] [CrossRef] [PubMed]
[16] Butkus, J.M., Sagalow, E.S., Alfonsi, S., Riordan, J., Zhan, T., McGettigan, B., et al. (2023) Prednisone Decreases Opioid Use in Adults Undergoing Benign Oropharyngeal Surgery. Otolaryngology—Head and Neck Surgery, 170, 405-413. [Google Scholar] [CrossRef] [PubMed]
[17] Mieszczanski, P., Gorniewski, G., Janiak, M. and Trzebicki, J. (2024) The Effect of Pre-Emptive Oral Pregabalin on Opioid Consumption in Patients Undergoing Laparoscopic Sleeve Gastrectomy with an Analysis of Intraoperative Hemodynamic Stability and Quality of Recovery: Study Protocol for a Randomized, Prospective, Double-Blind Study. Trials, 25, Article No. 367. [Google Scholar] [CrossRef] [PubMed]
[18] Sarac, B.A., Schoenbrunner, A.R., Brower, K.I., Joshi, G.P. and Janis, J.E. (2022) Analysis of Adverse Effects of Multimodal Gabapentin in Abdominal Wall Reconstruction. Plastic & Reconstructive Surgery, 149, 733-739. [Google Scholar] [CrossRef] [PubMed]
[19] 高碧聪, 张晓青, 谭红保, 等. 喉上神经阻滞联合右美托咪定对悬雍垂腭咽成形术后患者快速康复的影响[J]. 中国医刊, 2021, 56(12): 1364-1368.
[20] 何敏, 吴立. 超声下喉上神经阻滞复合右美托咪定对悬雍垂腭咽成形术后留置气管导管患者镇静镇痛的作用[J]. 中外医学研究, 2021, 19(25): 44-47.
[21] Li, N., Zhang, Y., Yang, F., Zhang, H., Yu, X., Lu, K., et al. (2023) Effects of Dexmedetomidine on Oxygenation and Inflammatory Factors in Patients Undergoing Uvulopalatopharyngoplasty: A Prospective, Randomized, Placebo-Controlled Trial. Sleep and Breathing, 27, 1099-1106. [Google Scholar] [CrossRef] [PubMed]
[22] Alvarez, A., Singh, P.M. and Sinha, A.C. (2014) Postoperative Analgesia in Morbid Obesity. Obesity Surgery, 24, 652-659. [Google Scholar] [CrossRef] [PubMed]
[23] 檀梦媛, 乔晓斐, 高晨, 等. 多模式镇痛对经腹肝部分切除术患者术后恢复质量的影响[J]. 临床麻醉学杂志, 2021, 37(6): 612-616.
[24] 刘艾竹, 关雷, 盛崴宣. 氟比洛芬酯联合不同剂量舒芬太尼用于改良悬雍垂腭咽成形术后镇痛[J]. 中国微创外科杂志, 2016, 16(4): 351-354.
[25] 陈敏, 戴洪山, 江志伟, 等. 多模式镇痛方案在腹腔镜袖状胃切除术后疼痛管理中的应用[J]. 中国药房, 2024, 35(21): 2658-2662.
[26] 张光远, 赵宇亮, 马建刚. 罗哌卡因用于UPPP患者术后镇痛的效果观察及对炎症和应激反应的影响[C]//中国睡眠研究会. 中国睡眠研究会第十四届全国学术年会论文汇编. 石家庄: 河北医科大学第二医院, 2022: 129.
[27] Li, L., Feng, J., Xie, S. and Geng, L. (2014) Preemptive Submucosal Infiltration with Ropivacaine for Uvulopalatopharyngoplasty. Otolaryngology—Head and Neck Surgery, 151, 874-879. [Google Scholar] [CrossRef] [PubMed]
[28] Haytoğlu, S., Arikan, O.K., Muluk, N.B. and Kuran, G. (2015) Relief of Pain at Rest and during Swallowing after Modified Cautery-Assisted Uvulopalatopharyngoplasty: Bupivacaine Versus Lidocaine. Journal of Craniofacial Surgery, 26, e216-e223. [Google Scholar] [CrossRef] [PubMed]
[29] Ponstein, N.A., Kim, T.E., Hsia, J., Goode, R., Borges, P. and Mariano, E.R. (2013) Continuous Lesser Palatine Nerve Block for Postoperative Analgesia after Uvulopalatopharyngoplasty. The Clinical Journal of Pain, 29, e35-e38. [Google Scholar] [CrossRef] [PubMed]
[30] Chen, Y., Lu, Y., Chang, T., Fang, H. and Lin, T. (2025) Can Preoperative Carbohydrate Drinks and Multimodal Analgesia Reduce Nausea, Vomiting, and Pain after Total Knee Arthroplasty? The Journal of Arthroplasty, 40, 3186-3193. [Google Scholar] [CrossRef] [PubMed]
[31] 贾真, 耿丽娜, 谢广伦, 等. 帕瑞昔布钠和氟比洛芬酯术前静注对腭咽成形术后镇痛及血小板聚集的影响[J]. 临床麻醉学杂志, 2014, 30(3): 269-272.
[32] Corso, R., Russotto, V., Gregoretti, C. and Cattano, D. (2018) Perioperative Management of Obstructive Sleep Apnea: A Systematic Review. Minerva Anestesiologica, 84, 81-93. [Google Scholar] [CrossRef] [PubMed]
[33] Cozowicz, C. and Memtsoudis, S.G. (2021) Perioperative Management of the Patient with Obstructive Sleep Apnea: A Narrative Review. Anesthesia & Analgesia, 132, 1231-1243. [Google Scholar] [CrossRef] [PubMed]
[34] Cozowicz, C., Zhong, H., Poeran, J., Illescas, A., Liu, J., Poultsides, L.A., et al. (2025) The Impact of Multimodal Analgesia in Coronary Artery Bypass Graft Surgery—A Population-Based Analysis. The Journal of Thoracic and Cardiovascular Surgery, 169, 105-113.e5. [Google Scholar] [CrossRef] [PubMed]
[35] Shim, J., Ko, J., Bae, J.H., Park, J., Lee, H.M., Kim, Y., et al. (2022) Pre-Emptive Multimodal Analgesic Bundle with Transversus Abdominis Plane Block Enhances Early Recovery after Laparoscopic Cholecystectomy. Asian Journal of Surgery, 45, 250-256. [Google Scholar] [CrossRef] [PubMed]
[36] Khaw, D., Bucknall, T., Considine, J., Duke, M., Hutchinson, A., Redley, B., et al. (2021) Six‐Year Trends in Postoperative Prescribing and Use of Multimodal Analgesics Following Total Hip and Knee Arthroplasty: A Single‐Site Observational Study of Pain Management. European Journal of Pain, 25, 107-121. [Google Scholar] [CrossRef] [PubMed]
[37] Rudolph, M.A., Rotsides, J.M. and Zapanta, P.E. (2018) The Patient’s Perioperative Perspective during the Treatment of Obstructive Sleep Apnea: A Pilot Study. Sleep and Breathing, 22, 997-1003. [Google Scholar] [CrossRef] [PubMed]
[38] Pankaja, S.S., Shetty, D., Madhu, C.P., Vasudevaiah, T. and V, A.M. (2023) Efficacy of Wound Instillation with Bupivacaine through a Wound Catheter for Postoperative Analgesia in Laparotomy Wounds in Comparison with Conventional Intravenous Analgesics. Cureus, 15, e38914. [Google Scholar] [CrossRef] [PubMed]
[39] Wang, H., Duan, C., Huang, W., Zhao, P., Zhou, L., Liu, Y., et al. (2021) Perioperative Intravenous S(+)-Ketamine for Acute Postoperative Pain in Adults: Study Protocol for a Multicentre, Randomised, Open-Label, Positive-Controlled, Pragmatic Clinical Trial (SAFE-SK-A Trial). BMJ Open, 11, e054681. [Google Scholar] [CrossRef] [PubMed]
[40] Julien-Marsollier, F., David, R., Hilly, J., Brasher, C., Michelet, D. and Dahmani, S. (2017) Predictors of Chronic Neuropathic Pain after Scoliosis Surgery in Children. Scandinavian Journal of Pain, 17, 339-344. [Google Scholar] [CrossRef] [PubMed]
[41] Kanna, R.M., Ramachandran, K., Subramanian, J.B., Shetty, A.P. and Rajasekaran, S. (2023) Perioperative Analgesic Efficacy and Safety of Erector Spinae Plane Block in Posterior Cervical Spine Surgery—A Double Blinded, Randomized Controlled Study. The Spine Journal, 23, 6-13. [Google Scholar] [CrossRef] [PubMed]

为你推荐