中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2015年
1期
57-60
,共4页
胃肿瘤%加速康复外科%预防性镇痛%胃切除术
胃腫瘤%加速康複外科%預防性鎮痛%胃切除術
위종류%가속강복외과%예방성진통%위절제술
Gastric neoplasms%Enhanced recovery after surgery%Preventive analgesia%Gastrectomy
目的 探讨预防性镇痛方案在胃癌患者行胃癌根治术中的应用价值.方法 选取2012年7月至2013年6月第四军医大学西京消化病医院行胃癌根治术的161例患者行前瞻性随机研究.采用随机、单盲对照法,通过随机数字表法将入组患者分为预防性镇痛组和对照组.两组患者行胃癌根治术,包括传统胃大部分切除联合毕Ⅱ式吻合术,或全胃切除联合食管空肠吻合术,术后均经空肠营养管给予肠内营养.预防性镇痛组开腹前给予地塞米松10 mg和帕瑞昔布200 mg静脉注射,开腹前、入腹后、关腹时在腹壁切口周围浸润注射0.5％罗哌卡因7～8 mL,术后连续3d口服塞来昔布.对照组仅在术后给予静脉留置管泵注入镇痛剂.记录2组患者视觉模拟评分(VAS)、术后每天下床活动时间＞8h的患者例数、术后肛门排气时间、术后排便时间、住院时间.正态分布的计量资料采用x±s表示,组间比较采用t检验和重复测量方差分析;偏态分布数据和等级资料采用秩和检验;计数资料采用四格表x2检验.结果 筛选出符合研究条件的患者161例,分为预防性镇痛组(87例)和对照组(74例).预防性镇痛组患者术后第1、2、3天VAS评分分别为(2.8±0.6)分、(2.6±0.4)分、(1.8±0.4)分,对照组患者分别为(5.3±0.5)分、(4.2±0.6)分、(2.4±0.3)分,两组比较,差异有统计学意义(F=4.25,P＜0.05).预防性镇痛组患者术后第1、2、3天每天下床活动时间＞8h的例数分别为8、17、20例,对照组分别为0、3、11例,两组比较,差异有统计学意义(x2=7.60,10.26,3.16,P＜0.05).预防性镇痛组患者术后肛门排气时间、术后排便时间和术后住院时间分别为(51 ±24)h、(61 ±24)h、(5.5 ±3.0)d,对照组分别为(71 ±23)h、(83±30)h、(6.3±2.1)d,两组比较,差异有统计学意义(t=5.32,5.04,0.17,P＜0.05).两组患者术后均顺利康复,未出现呼吸抑制和切口感染等并发症及药物不良反应.结论 胃癌患者施行胃癌根治术围术期采用预防性镇痛方案,可减轻患者术后疼痛,促进患者肠道功能恢复,加速患者术后康复.临床试验注册在中国临床试验注册中心注册,注册号为ChiCTR-TRC-11001440.
目的 探討預防性鎮痛方案在胃癌患者行胃癌根治術中的應用價值.方法 選取2012年7月至2013年6月第四軍醫大學西京消化病醫院行胃癌根治術的161例患者行前瞻性隨機研究.採用隨機、單盲對照法,通過隨機數字錶法將入組患者分為預防性鎮痛組和對照組.兩組患者行胃癌根治術,包括傳統胃大部分切除聯閤畢Ⅱ式吻閤術,或全胃切除聯閤食管空腸吻閤術,術後均經空腸營養管給予腸內營養.預防性鎮痛組開腹前給予地塞米鬆10 mg和帕瑞昔佈200 mg靜脈註射,開腹前、入腹後、關腹時在腹壁切口週圍浸潤註射0.5％囉哌卡因7～8 mL,術後連續3d口服塞來昔佈.對照組僅在術後給予靜脈留置管泵註入鎮痛劑.記錄2組患者視覺模擬評分(VAS)、術後每天下床活動時間＞8h的患者例數、術後肛門排氣時間、術後排便時間、住院時間.正態分佈的計量資料採用x±s錶示,組間比較採用t檢驗和重複測量方差分析;偏態分佈數據和等級資料採用秩和檢驗;計數資料採用四格錶x2檢驗.結果 篩選齣符閤研究條件的患者161例,分為預防性鎮痛組(87例)和對照組(74例).預防性鎮痛組患者術後第1、2、3天VAS評分分彆為(2.8±0.6)分、(2.6±0.4)分、(1.8±0.4)分,對照組患者分彆為(5.3±0.5)分、(4.2±0.6)分、(2.4±0.3)分,兩組比較,差異有統計學意義(F=4.25,P＜0.05).預防性鎮痛組患者術後第1、2、3天每天下床活動時間＞8h的例數分彆為8、17、20例,對照組分彆為0、3、11例,兩組比較,差異有統計學意義(x2=7.60,10.26,3.16,P＜0.05).預防性鎮痛組患者術後肛門排氣時間、術後排便時間和術後住院時間分彆為(51 ±24)h、(61 ±24)h、(5.5 ±3.0)d,對照組分彆為(71 ±23)h、(83±30)h、(6.3±2.1)d,兩組比較,差異有統計學意義(t=5.32,5.04,0.17,P＜0.05).兩組患者術後均順利康複,未齣現呼吸抑製和切口感染等併髮癥及藥物不良反應.結論 胃癌患者施行胃癌根治術圍術期採用預防性鎮痛方案,可減輕患者術後疼痛,促進患者腸道功能恢複,加速患者術後康複.臨床試驗註冊在中國臨床試驗註冊中心註冊,註冊號為ChiCTR-TRC-11001440.
목적 탐토예방성진통방안재위암환자행위암근치술중적응용개치.방법 선취2012년7월지2013년6월제사군의대학서경소화병의원행위암근치술적161례환자행전첨성수궤연구.채용수궤、단맹대조법,통과수궤수자표법장입조환자분위예방성진통조화대조조.량조환자행위암근치술,포괄전통위대부분절제연합필Ⅱ식문합술,혹전위절제연합식관공장문합술,술후균경공장영양관급여장내영양.예방성진통조개복전급여지새미송10 mg화파서석포200 mg정맥주사,개복전、입복후、관복시재복벽절구주위침윤주사0.5％라고잡인7～8 mL,술후련속3d구복새래석포.대조조부재술후급여정맥류치관빙주입진통제.기록2조환자시각모의평분(VAS)、술후매천하상활동시간＞8h적환자례수、술후항문배기시간、술후배편시간、주원시간.정태분포적계량자료채용x±s표시,조간비교채용t검험화중복측량방차분석;편태분포수거화등급자료채용질화검험;계수자료채용사격표x2검험.결과 사선출부합연구조건적환자161례,분위예방성진통조(87례)화대조조(74례).예방성진통조환자술후제1、2、3천VAS평분분별위(2.8±0.6)분、(2.6±0.4)분、(1.8±0.4)분,대조조환자분별위(5.3±0.5)분、(4.2±0.6)분、(2.4±0.3)분,량조비교,차이유통계학의의(F=4.25,P＜0.05).예방성진통조환자술후제1、2、3천매천하상활동시간＞8h적례수분별위8、17、20례,대조조분별위0、3、11례,량조비교,차이유통계학의의(x2=7.60,10.26,3.16,P＜0.05).예방성진통조환자술후항문배기시간、술후배편시간화술후주원시간분별위(51 ±24)h、(61 ±24)h、(5.5 ±3.0)d,대조조분별위(71 ±23)h、(83±30)h、(6.3±2.1)d,량조비교,차이유통계학의의(t=5.32,5.04,0.17,P＜0.05).량조환자술후균순리강복,미출현호흡억제화절구감염등병발증급약물불량반응.결론 위암환자시행위암근치술위술기채용예방성진통방안,가감경환자술후동통,촉진환자장도공능회복,가속환자술후강복.림상시험주책재중국림상시험주책중심주책,주책호위ChiCTR-TRC-11001440.
Objective To investigate the clinical value of preventive analgesia in patients with radical gastrectomy for gastric cancer.Methods The clinical data of 161 patients undergoing radical gastrectomy for gastric cancer at the Xijing Hospital from July 2012 to June 2013 were prospectively analyzed.A single-blind,randomized,controlled study was performed in the eligibe patients who were randomly divided into the preventive analgesia group and the control group based on a random number table.All the patients received major gastrectomy + Billroth Ⅱ anastomy or total gastrectomy + esophagojejunastomy,and then they received vein combined anesthesia and tracheal intubation.In the preventive analgesia group,10 mg dexamethasone and 200 mg parecoxib were administered by intravenous infusion before operation,7-8 mL ropivacaine (0.5％) were injected at the incisional site and transversus abdominis infiltration at open and close surgery and celecoxib was taken orally for 3 days.In the control group,vein analgesia pump was used after operation.The visual analogue scale (VAS),proportion of patients with postoperative out-off-bed activity time ＞ 8 hours,time of flatus,time of defecation and duration of hospital stay were recorded between the 2 groups.The measurement data with normal distribution were presented as x ± s.The comparison between groups was evaluated with the t test and repeated measures ANOVA.The data with skew distrubution and ordinal data were analyzed by the analysis of variance,and the count data were analyzed using the chi-square test.Results All the 161 patients who were screened for eligibility were randomly divided into the preventive analgesia group (87 patients) and the control group (74 patients).The scores of the VAS at postoperative day 1,2 and 3 were 2.8 ± 0.6,2.6 ± 0.4 and 1.8 ± 0.4 in the preventive analgesia group,and 5.3 ± 0.5,4.2 ± 0.6 and 2.4 ± 0.3 in the control group,with a significant difference between the 2 groups (F =4.25,P ＜ 0.05).The proportion of patients with postoperative first abmulation time ＞ 8 hours at postoperative day 1,2 and 3 were 8,17 and 20 in the preventive analgesia group,and 0,3 and 11 in the control group,with a significant difference between the 2 groups (x2 =7.60,10.26,3.16,P ＜ 0.05).The time of flatus,time of defecation and duration of hospital stay were (51 ± 24) hours,(61 ± 24) hours and (5.5 ± 3.0) days in the preventive analgesia group,compared with (71 ± 23) hours,(83 ± 30) hours and (6.3 ± 2.1) days in the control group,showing a significant difference between the 2 groups (t =5.32,5.04,0.17,P ＜ 0.05).All the patients in the 2 groups normally survived after surgery without respiratory depression,incision infection and adverse drug reaction.Conclusions Preventive analgesia in the perioperative treatment of patients with radical gastrectomy for gastric cancer could relieve the postoperative pain of patients,improve the bowel function and enhance the recovery of patients.Registry This study was registered with the Chinese Clinical Trial Registry with the registry number of ChiCTRTRC-11001440.
