多模式镇痛对老年腹部手术患者术中阿片类药物使用量及术后康复情况的影响

Effect of Multimodal Analgesia on Intraoperative Opioid Use and Postoperative Rehabilitation in Elderly Patients Undergoing Abdominal Surgery

摘要: 目的：探讨多模式镇痛对老年腹部手术患者术中阿片类药物使用量及术后康复情况的影响。方法：2022年1月~12月在烟台毓璜顶医院进行择期腹腔镜或开腹腹部手术(胃、胆囊、肝脏、胰腺、脾脏)的患者120例，随机分为对照组和多模式镇痛组，每组60例。对照组术中全凭静脉全身麻醉，多模式镇痛组麻醉诱导后使用静脉注射帕瑞昔布钠40 mg，并行切口局部浸润麻醉或者双侧腹横肌平面神经阻滞；对照组术后镇痛泵舒芬太尼，多模式镇痛组术后镇痛泵右美托咪定 + 布托啡诺。对比两组术中阿片类药物使用情况；对比两组术后不同时间点静息和活动时疼痛视觉模拟法(VAS)评分、术后24 h镇痛泵总按压次数、术后不良反应的发生情况、术后首次排气时间、首次下床活动时间以及术后生活质量等。结果：多模式镇痛组患者的术中阿片类药物使用量低于对照组，差异有统计学意义(P < 0.05)；多模式镇痛组的术后1 h、2 h、4 h、12 h和24 h静息及活动时疼痛VAS评分低于对照组，差异有统计学意义(P < 0.05)；多模式镇痛组术后24 h患者自控镇痛按压次数低于对照组，差异有统计学意义(P < 0.05)；在多模式镇痛组中，术后首次排气时间和首次下床活动时间均显著缩短，与对照组相比，差异具有显著统计学意义(P < 0.05)。多模式镇痛组术后生活质量评分较对照组高，差异有统计学意义(P < 0.05)。在两组患者中，对于镇痛效果的满意度以及术后不良反应的发生率，未发现显著差异(P > 0.05)，表明两组患者在此方面的差异并不具有统计学意义。结论：老年腹部手术患者术中阿片类药物用量的减少和术后康复的加速，可以通过采用多种镇痛模式来实现。

Abstract: Objective: To investigate the effects of multimodal analgesia on intraoperative opioid consumption and postoperative rehabilitation in elderly patients undergoing abdominal surgery. Methods: From January to December 2022, 120 patients undergoing elective laparoscopic or open abdominal sur-gery (stomach, gallbladder, liver, pancreas, spleen) in Yuhuangding Hospital of Yantai were ran-domly divided into control group and multi-mode analgesia group, with 60 cases in each group. The control group was given intravenous general anesthesia during the operation, and the multi-mode analgesia group was given intravenous parecoxib sodium 40 mg + incision local infiltration anes-thesia + bilateral transverse abdominal plane nerve block after anesthesia induction. Sufentanil was the postoperative analgesic pump in the control group, dexmedetomidine + butorphanol was the postoperative analgesic pump in the multi-mode analgesic group. Intraoperative opioid use was compared between the two groups. The VAS score of resting and active pain at different time points after surgery, the total number of analgesic pump compressions 24 h after surgery, the occurrence of postoperative adverse reactions, the first postoperative exhaust time, the first time to get out of bed and the postoperative quality of life were compared between the two groups. Results: The in-traoperative opioid consumption in multi-mode analgesia group was lower than that in control group, the difference was statistically significant (P < 0.05). Pain VAS scores at 1 h, 2 h, 4 h, 12 h and 24 h in the multi-mode analgesia group were lower than those in the control group, and the differ-ence was statistically significant (P < 0.05). The number of patient-controlled analgesia press 24 h after operation in the multi-mode analgesia group was lower than that in the control group, and the difference was statistically significant (P < 0.05). The time of first discharge and the time of first get-ting out of bed in the multi-mode analgesia group were shorter than those in the control group, and the difference was statistically significant (P < 0.05). The score of postoperative quality of life in multi-mode analgesia group was higher than that in control group, and the difference was statisti-cally significant (P < 0.05). There was no significant difference in satisfaction with analgesic effect and incidence of postoperative adverse reactions between 2 groups (P > 0.05). Conclusion: Multi-modal analgesia can reduce intraoperative opioid consumption and accelerate postoperative re-covery in elderly patients undergoing abdominal surgery.