摘要
目的:探讨围术期多模式联合预防性镇痛对胸腔镜肺叶切除术后肺功能快速康复的影响及临床意义。方法:胸腔镜肺叶切除手术患者150例,随机分为3组,A组:术后前5 d予以帕瑞昔布40 mg/d静脉注射,2次/天;B组:术后前5 d予以帕瑞昔布40 mg/d静脉注射,2次/天,患者疼痛时予以氨酚羟考酮330 mg口服止痛;C组:术后前5 d予以帕瑞昔布40 mg/d静脉注射,2次/天,每天不论患者有无疼痛均定时给予氨酚羟考酮330 mg口服,3次/天。应用疼痛数字评分法(NRS)每天6时、10时、14时、22时对患者术后5 d进行疼痛评分,比较各组患者镇痛效果;检测比较术后第1、3、5、7天降钙素原、早8点血清皮质醇水平,观察比较各组术后肺部感染发生情况、气道分泌物排除情况、胸腔引流管留置时间、住院时间。结果:C组在术后第1~3天疼痛评分低于A、B两组,B组在术后第1、2天疼痛评分低于A组,差异均有统计学意义(P<0.05),第4天以后,A、B、C三组差异无统计学意义(P>0.05);B、C组术后第1~3天血清皮质醇水平较A组低,C组术后第1天较B组低,差异有统计学意义(P<0.05),第4、5天三组差异无统计学意义(P>0.05);术后各时间点降钙素水平间差异无统计学意义(P>0.05);B、C组在术后肺部感染发生率、肺不张发生率较A组低(P<0.05),胸腔引流管留置时间、住院时间较A组短,差异有统计学意义(P<0.05)。结论:多模式联合预防性镇痛在胸腔镜肺叶切除术后表现出更好的镇痛效果,可减少术后应激反应及肺部感染发生,缩短住院时间,有利于患者术后快速康复。
Objective To investigate the effect and clinical significance of perioperative multimodal analgesia combined with preventive analgesia on rapid recovery of lung function after thoracoscopic lobectomy.Methods 150 patients with lung lobectomy were randomly divided into three groups:Group A:40 mg/d parecoxib was given intravenously on the first 5 days after surgery 2 times a day,Group B:40 mg/d parecoxib was given intravenously 2 times a day on the first 5 days after surgery,and the patient was given tylox 330 mg orally for pain relief;Group C:parecoxib 40 mg/d was given intravenously 2 times a day on the first 5 days after surgery,and regardless of whether the patient has pain or not,tylox 330 mg orally were given regularly,3 times a day.The pain numerical scale(NRS)was used to score the pain of the patients on the 5th day after surgery at 6:00,10:00,14:00 and 22:00 every day.The analgesic effect of the patients in each group was compared.Procalcitonin and serum cortisol levels at 8:00 were detected and compared on the 1st,3rd,5th and 7th day after the surgery.The incidence of postoperative pulmonary infection,the elimination of airway secretion,the indwelling time of thoracic drainage tube and the length of hospital stay were observed and compared.Results The pain score of group C was lower than that of group A and group B on the 1st to 3rd day after surgery,and the pain score of group B was lower than that of group A on the 1st and 2nd day after surgery.The differences were statistically significant(P<0.05).After 4th day,there was no statistically significant difference between the three groups A,B,and C(P>0.05).The serum cortisol level in groups B and C were lower than that in group A on the 1st to 3rd day after surgery,and that of group C was lower than that of group B on the 1st day after surgery,with statistically significant differences(P<0.05).The difference between the three groups on the 4th and 5th day was not statistically significant(P>0.05).There was no statistically significant difference in the leve
作者
张俊
罗湘玉
张立
梁晓燕
王燕
ZHANG Jun;LUO Xiang-yu;ZHANG Li;LIANG Xiao-yan;WANG Yan(Department of Cardiotho-racic Surgery,Taihe Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)
出处
《湖北医药学院学报》
CAS
2021年第1期11-15,共5页
Journal of Hubei University of Medicine
关键词
预防性镇痛
胸腔镜
肺癌
快速康复
Preventive analgesia
Video-assistant thoracoscopic
Lung cancer
Enhanced recovery after surgery
