帕瑞昔布联合脐上小切口用于腹腔镜肝部分切除术后镇痛的临床疗效
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摘要
目的:探讨帕瑞昔布联合脐上小切口用于腹腔镜肝部分切除术后的镇痛管理。方法:选择2013年8月至2017年1月诊治的72例肝肿瘤患者,按照肿瘤大小、肿瘤部位、手术方式及切口长度等配对入组,按照术后镇痛方法不同分为经静脉患者自控镇痛(PCIA)组(n=36)和帕瑞昔布组(n=36)。所有患者均行腹腔镜肝部分切除术,并经脐上小切口取出标本。术后PCIA组采用经静脉患者自控镇痛(舒芬太尼250μg+0.9%氯化钠液250mL,持续静脉滴注1mL/h,单次追加量6μg,锁定时间6min),帕瑞昔布组采用帕瑞昔布镇痛(术后即刻40mg静脉滴注;q12h×术后3d)。采用视觉模拟评分(VAS)法比较术后镇痛效果,同时比较两组患者的术后排气时间、导尿管留置时间、下床活动时间、不良反应等。结果:两组术后1、6、12、24、48、72h的静态VAS评分与术后6、12、24、48、72h的动态VAS评分差异均无统计学意义。术后排气时间:PCIA组为(48.2+4.3)h,帕瑞昔布组为(31.3±3.1)h;尿管留置时间:PCIA组为(42.9±2.8)h,帕瑞昔布组为(19.1±1.4)h;下床活动时间:PCIA组为(45.3±5.3)h,帕瑞昔布组为(22.1±2.8)h,差异均有统计学意义(P<0.001)。PCIA组6例术后发生恶心、呕吐(16.7%),3例皮肤瘙痒(8.3%),6例头晕(16.7%);帕瑞昔布组无恶心呕吐、低血压、眩晕等发生。结论:帕瑞昔布联合脐上小切口用于腹腔镜肝部分切除术后镇痛可达到良好镇痛效果,术后恢复快,无显著不良反应。
Objective:To explore the efficacy of parecoxib combined with small supraumbilical incision in analgesia management after laparoscopic partial hepatectomy.Methods:From August 2013 to January 2017,72 patients with liver tumors were enrolled and divided into two groups according to the tumor size,tumor location,type of operation,and incision length:patient-controlled intravenous analgesia(PCIA)group(n=36)and parecoxib group(n=36).All the cases underwent laparoscopic partial hepatectomy and the specimens were removed from small supraumbilical incision.The patients in PCIA group received postoperative analgesia using PCIA(sufentanil 250μg + NS 250 mL,1 mL/h pumping,bolus 6 mg/6 min),while those in parecoxib group were subjected to intravenous injection of parecoxib(40 mg i.v.,immediately after surgery and q12 h×3 dpostoperatively).The visual analogue scale(VAS)was used to assess the degree of postoperative pain.The time of bowel flatus and mobilisation,duration of catheter withdrawal and adverse effects were compared between the two groups.Results:There were no significant differences in the static VAS scores at time points of 1 h,6 h,12 h,24 h,48 hand 72 h after surgery and the dynamic VAS score at time points of 6 h,12 h,24 h,48 hand 72 hafter surgery between the two groups.The time of bowel flatus,time of mobilization and duration of catheter withdrawal in parecoxib group was(31.3±3.1),(22.1±2.8)and(19.1±1.4)h,respectively,all being significantly shorter than those in PCIA group([48.2+4.3],[45.3±5.3]and[42.9±2.8]h,all P<0.001).There were 6 cases of nausea and vomiting(16.7%),3 cases of pruritus(8.3%),and 6 cases of dizziness(16.7%)in PCIA group,while no adverse effect was observed in parecoxib group.Conclusions:Analgesia using parecoxib combined with small supraumbilical incision has good analgesic effect in laparoscopic partial hepatectomy,which can facilitate a faster postoperative recovery with minimal adverse effects.
Objective:To explore the efficacy of parecoxib combined with small supraumbilical incision in analgesia management after laparoscopic partial hepatectomy.Methods:From August 2013 to January 2017,72 patients with liver tumors were enrolled and divided into two groups according to the tumor size,tumor location,type of operation,and incision length:patient-controlled intravenous analgesia(PCIA)group(n=36)and parecoxib group(n=36).All the cases underwent laparoscopic partial hepatectomy and the specimens were removed from small supraumbilical incision.The patients in PCIA group received postoperative analgesia using PCIA(sufentanil 250μg + NS 250 mL,1 mL/h pumping,bolus 6 mg/6 min),while those in parecoxib group were subjected to intravenous injection of parecoxib(40 mg i.v.,immediately after surgery and q12 h×3 dpostoperatively).The visual analogue scale(VAS)was used to assess the degree of postoperative pain.The time of bowel flatus and mobilisation,duration of catheter withdrawal and adverse effects were compared between the two groups.Results:There were no significant differences in the static VAS scores at time points of 1 h,6 h,12 h,24 h,48 hand 72 h after surgery and the dynamic VAS score at time points of 6 h,12 h,24 h,48 hand 72 hafter surgery between the two groups.The time of bowel flatus,time of mobilization and duration of catheter withdrawal in parecoxib group was(31.3±3.1),(22.1±2.8)and(19.1±1.4)h,respectively,all being significantly shorter than those in PCIA group([48.2+4.3],[45.3±5.3]and[42.9±2.8]h,all P<0.001).There were 6 cases of nausea and vomiting(16.7%),3 cases of pruritus(8.3%),and 6 cases of dizziness(16.7%)in PCIA group,while no adverse effect was observed in parecoxib group.Conclusions:Analgesia using parecoxib combined with small supraumbilical incision has good analgesic effect in laparoscopic partial hepatectomy,which can facilitate a faster postoperative recovery with minimal adverse effects.
引文
[1]BERARDI G,VAN CLEVEN S,FRETLANDA,et al.Evolution of laparoscopic liver surgery from innovation to implementation to mastery:perioperative and oncologic outcomes of 2,238 patients from 4 European Specialized Centers[J].J Am Coll Surg,2017,225(5):639-649.
[2]TRANCHART H,FUKS D,LAINAS P,et al.Laparoscopic liver surgery:towards a day-case management[J].Surg Endosc,2017,31(12):5295-5302.
[3]ALLEN S,DEROCHE A,ADAMS L,et al.Effect of epidural compared to patient-controlled intravenous analgesia on outcomes for patients undergoing liver resection for neoplastic disease[J].J Surg Oncol,2017,115(4):402-406.
[4]FAYED N A,ABO EL-WAFA H B,GAB-ALLA N M,et al.Comparison between intravenous patient controlled analgesia and patient controlled epidural analgesia in cirrhotic patients after hepatic resection[J].Middle East J Anaesthesiol,2014,22(5):467-476.
[5]彭远飞,陈霏雨,王征,等.PCEA单独或联合帕瑞昔布用于腹腔镜肝左外叶切除术后镇痛的对比研究[J].中国临床医学,2017,24(2):233-237.
[6]NI T G,YANG H T,ZHANG H,et al.Enhanced recovery after surgery programs in patients undergoing hepatectomy:a meta-analysis[J].World J Gastroenterol,2015,21(30):9209-9216.
[7]YANG R,TAO W,CHEN Y Y,et al.Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy:a meta-analysis[J].Int J Surg,2016,36(Pt A):274-282.
[8]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.
[9]刘连新,陈亚进,曹铭辉,等.腹腔镜肝切除术加速康复外科中国专家共识(2017版)[J].中国实用外科杂志,2017,(5):517-524.
[10]中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].中华消化外科杂志,2016,15(1):1-6.
[11]冷希圣,韦军民,刘连新,等.普通外科围手术期疼痛处理专家共识[J].中华普通外科杂志,2015,30(2):166-173.
[12]WALIA A.Anesthetic management for liver resection[J].J Gastrointest Surg,2006,10(2):168-169.
[13]TZIMAS P,PROUT J,PAPADOPOULOS G,et al.Epidural anaesthesia and analgesia for liver resection[J].Anaesthesia,2013,68(6):628-635.
[2]TRANCHART H,FUKS D,LAINAS P,et al.Laparoscopic liver surgery:towards a day-case management[J].Surg Endosc,2017,31(12):5295-5302.
[3]ALLEN S,DEROCHE A,ADAMS L,et al.Effect of epidural compared to patient-controlled intravenous analgesia on outcomes for patients undergoing liver resection for neoplastic disease[J].J Surg Oncol,2017,115(4):402-406.
[4]FAYED N A,ABO EL-WAFA H B,GAB-ALLA N M,et al.Comparison between intravenous patient controlled analgesia and patient controlled epidural analgesia in cirrhotic patients after hepatic resection[J].Middle East J Anaesthesiol,2014,22(5):467-476.
[5]彭远飞,陈霏雨,王征,等.PCEA单独或联合帕瑞昔布用于腹腔镜肝左外叶切除术后镇痛的对比研究[J].中国临床医学,2017,24(2):233-237.
[6]NI T G,YANG H T,ZHANG H,et al.Enhanced recovery after surgery programs in patients undergoing hepatectomy:a meta-analysis[J].World J Gastroenterol,2015,21(30):9209-9216.
[7]YANG R,TAO W,CHEN Y Y,et al.Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy:a meta-analysis[J].Int J Surg,2016,36(Pt A):274-282.
[8]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.
[9]刘连新,陈亚进,曹铭辉,等.腹腔镜肝切除术加速康复外科中国专家共识(2017版)[J].中国实用外科杂志,2017,(5):517-524.
[10]中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].中华消化外科杂志,2016,15(1):1-6.
[11]冷希圣,韦军民,刘连新,等.普通外科围手术期疼痛处理专家共识[J].中华普通外科杂志,2015,30(2):166-173.
[12]WALIA A.Anesthetic management for liver resection[J].J Gastrointest Surg,2006,10(2):168-169.
[13]TZIMAS P,PROUT J,PAPADOPOULOS G,et al.Epidural anaesthesia and analgesia for liver resection[J].Anaesthesia,2013,68(6):628-635.