多模式镇痛对肺癌患者术后肺部感染及肺功能的影响
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摘要
目的分析多模式镇痛对肺癌患者术后肺部感染及肺功能的影响,为医院感染的预防和控制工作提供客观依据。方法选取2017年1月-2018年1月行手术治疗的80例早期肺癌患者作为研究对象,将其分为研究组和对照组。对照组患者给予术后硬膜外自控镇痛,研究组患者给予超前镇痛联合术后硬膜外自控镇痛。观察两组患者术后肺部感染情况,应用视觉模拟评分法(VAS)对两组患者术后24h、48h、72h进行评分,比较两组患者术前和术后72h最大通气量(MVV)、用力呼气第1秒量(FEV_1)、用力肺活量(FVC)等肺功能指标。对两组患者术后不良反应进行观察和比较。结果对照组和研究组中分别有13例和3例患者于术后发生肺部感染,感染率分别为32.5%和7.5%,差异有统计学意义(P<0.05);术后48h和72h,研究组患者VAS评分均低于对照组(P<0.05);术后72h,研究组患者肺功能指标均优于对照组(P<0.05)。两组患者术后均出现恶心呕吐、头晕、嗜睡等不良反应。结论在肺癌手术中应用超前镇痛联合术后硬膜外自控镇痛的多模式镇痛方式,能够降低患者术后肺部感染率,有效缓解术后疼痛和手术对肺功能的损害,降低术后并发症的发生率。
OBJECTIVE To explore the influence of multimodal analgesia on postoperative pulmonary infection and lung function of the lung cancer patients so as to provide guidance for prevention and control of nosocomial infection.METHODS A total of 80 patients with early stage of lung cancer who received surgical procedures from Jan2017 to Jan 2018 were recruited as the study objects and divided into the study group and the control group.The control group was given patient-controlled epidural analgesia after the surgery,while the study group was treated with preemptive analgesia combined with postoperative patient-controlled epidural analgesia.The prevalence of postoperative pulmonary infection was observed,the visual analogue scale(VAS)scores were recorded at 24 h,48 hand 72 hafter the surgery,the lung function indexes such as maximum ventilation volume(MVV),forced expiratory volume in 1 st second(FEV_1)and forced vital capacity(FVC)were compared between the two groups of patients before the surgery and after the surgery for 72 hours,and the postoperative adverse reactions were observed and compared between the two groups of patients.RESULTS Totally 13 patients had postoperative pulmonary infection in the control group,3 patients in the study group;the infection rates were 32.5% and 7.5%,respectively,and there was significant difference(P<0.05).The VAS scores of the study group were significantly lower than those of the control group after the surgery for 48 and 72 hours(P<0.05).The lung function indexes of the study group were significantly better than those of the control group(P<0.05).Both groups of patients had adverse reactions such as nausea and vomiting,dizziness and lethargy after the surgery.CONCLUSION The preemptive analgesia combined with patient-controlled epidural analgesia may reduce the incidence of postoperative pulmonary infection in the lung cancer patients,effectively alleviate the damage of lung function due to postoperative pain and surgery and reduce the incidence of postoperative complications.
OBJECTIVE To explore the influence of multimodal analgesia on postoperative pulmonary infection and lung function of the lung cancer patients so as to provide guidance for prevention and control of nosocomial infection.METHODS A total of 80 patients with early stage of lung cancer who received surgical procedures from Jan2017 to Jan 2018 were recruited as the study objects and divided into the study group and the control group.The control group was given patient-controlled epidural analgesia after the surgery,while the study group was treated with preemptive analgesia combined with postoperative patient-controlled epidural analgesia.The prevalence of postoperative pulmonary infection was observed,the visual analogue scale(VAS)scores were recorded at 24 h,48 hand 72 hafter the surgery,the lung function indexes such as maximum ventilation volume(MVV),forced expiratory volume in 1 st second(FEV_1)and forced vital capacity(FVC)were compared between the two groups of patients before the surgery and after the surgery for 72 hours,and the postoperative adverse reactions were observed and compared between the two groups of patients.RESULTS Totally 13 patients had postoperative pulmonary infection in the control group,3 patients in the study group;the infection rates were 32.5% and 7.5%,respectively,and there was significant difference(P<0.05).The VAS scores of the study group were significantly lower than those of the control group after the surgery for 48 and 72 hours(P<0.05).The lung function indexes of the study group were significantly better than those of the control group(P<0.05).Both groups of patients had adverse reactions such as nausea and vomiting,dizziness and lethargy after the surgery.CONCLUSION The preemptive analgesia combined with patient-controlled epidural analgesia may reduce the incidence of postoperative pulmonary infection in the lung cancer patients,effectively alleviate the damage of lung function due to postoperative pain and surgery and reduce the incidence of postoperative complications.
引文
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[14]Bonetta A,Roviello G,Generali D,et al.Enteric-coated and highly standardized cranberry extract reduces antibiotic and nonsteroidal anti-inflammatory drug use for urinary tract infections during radiotherapy for prostate carcinoma[J].Res Rep Urol,2017,9:65-69.
[15]Xiong J,Krishnaswamy G,Raynor S,et al.Risk of swallowing-related chest infections in patients with nasopharyngeal carcinoma treated with definitive intensity-modulated radiotherapy[J].Head Neck,2016,Suppl 1:E1660-E1665.
[16]Rutkowski A,Zajac L,Pietrzak L,et al.Surgical site infections following short-term radiotherapy and total mesorectal excision:results of a randomized study examining the role of gentamicin collagen implant in rectal cancer surgery[J].Tech Coloproctol,2014,18(10):921-928.
[17]Zhang J,Wang Y,Yang G,et al.Effects of comprehensive rehabilitation training in combination with multi-mode analgesia on body function recovery after tumor-type knee replacement[J].Pak J Med Sci,2016,32(5):1240-1245.
[18]Newton-Brown E,Fitzgerald L,Mitra B.Audit improves emergency department triage,assessment,multi-modal analgesia and nerve block use in the management of pain in older people with neck of femur fracture[J].Australas Emerg Nurs J,2014,17(4):176-183.
[19]杨娇,曹海,王世强,等.多镇痛模式联合术后干预对高龄关节置换术患者术后感染及疼痛状态的比较研究[J].中华医院感染学杂志,2016,26(24):5641-5644.
[2]Cheng X,Chen H.Commentary on the impacts of postoperative complications on survival after lung cancer surgery[J].JThorac Cardiovasc Surg,2018,155(3):1265-1266.
[3]Li Y,Qi D,Gong L,et al.Effect of auricular points treatment combined with acupoints application in patients with constipation after lung cancer surgery[J].J Cancer Res Ther,2017,13(5):844-848.
[4]Tandberg DJ,Tong BC,Ackerson BG,et al.Surgery versus stereotactic body radiation therapy for stage I non-small cell lung cancer:a comprehensive review[J].Cancer,2018,124(4):667-678.
[5]Kim SW,Hong JM,Kim D.What is difficult about doing video-assisted thoracic surgery(VATS)?A retrospective study comparing VATS anatomical resection and conversion to thoracotomy for lung cancer in a university-based hospital[J].JThorac Dis,2017,9(10):3825-3831.
[6]中华人民共和国卫生部,中华医院管理学会医院感染管理专业委员会.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[7]Langley GB,Sheppeard H.The visual analogue scale:its use in pain measurement[J].Rheumatol Int,1985,5(4):145-148.
[8]张化芝,郭晓烨,李晓双,等.肺癌术后并发肺部感染的病原学分析及影响因素分析[J].中华医院感染学杂志,2018,28(1):77-80.
[9]刘联斌,黄刚,郭守俊,等.晚期肺癌患者化疗后肺部感染的病原菌分布和对免疫功能的影响研究[J].中华医院感染学杂志,2017,27(22):5105-5108.
[10]Berahmat R,Mahami-Oskouei M,Rezamand A,et al.Cryptosporidium infection in children with cancer undergoing chemotherapy:how important is the prevention of opportunistic parasitic infections in patients with malignancies[J].Parasitol Res,2017,116(9):2507-2515.
[11]Tormo M,Perez-Martinez A,Calabuig M,et al.Primary prophylaxis of invasive fungal infections with posaconazole or itraconazole in patients with acute myeloid leukaemia or high-risk myelodysplastic syndromes undergoing intensive cytotoxic chemotherapy:a real-world comparison[J].Mycoses,2018,61(3):206-212.
[12]Castagnola E,Ruberto E,Guarino A.Gastrointestinal and liver infections in children undergoing antineoplastic chemotherapy in the years 2000[J].World J Gastroenterol,2016,22(25):5853-5866.
[13]张定富,吴秋芳,戈长征.肺癌放疗后继发肺部感染患者呼吸功能与炎性状态的变化观察[J].实用癌症杂志,2017,33(6):963-965.
[14]Bonetta A,Roviello G,Generali D,et al.Enteric-coated and highly standardized cranberry extract reduces antibiotic and nonsteroidal anti-inflammatory drug use for urinary tract infections during radiotherapy for prostate carcinoma[J].Res Rep Urol,2017,9:65-69.
[15]Xiong J,Krishnaswamy G,Raynor S,et al.Risk of swallowing-related chest infections in patients with nasopharyngeal carcinoma treated with definitive intensity-modulated radiotherapy[J].Head Neck,2016,Suppl 1:E1660-E1665.
[16]Rutkowski A,Zajac L,Pietrzak L,et al.Surgical site infections following short-term radiotherapy and total mesorectal excision:results of a randomized study examining the role of gentamicin collagen implant in rectal cancer surgery[J].Tech Coloproctol,2014,18(10):921-928.
[17]Zhang J,Wang Y,Yang G,et al.Effects of comprehensive rehabilitation training in combination with multi-mode analgesia on body function recovery after tumor-type knee replacement[J].Pak J Med Sci,2016,32(5):1240-1245.
[18]Newton-Brown E,Fitzgerald L,Mitra B.Audit improves emergency department triage,assessment,multi-modal analgesia and nerve block use in the management of pain in older people with neck of femur fracture[J].Australas Emerg Nurs J,2014,17(4):176-183.
[19]杨娇,曹海,王世强,等.多镇痛模式联合术后干预对高龄关节置换术患者术后感染及疼痛状态的比较研究[J].中华医院感染学杂志,2016,26(24):5641-5644.