多模式镇痛在达芬奇机器人辅助根治性膀胱全切除联合原位回肠新膀胱术中的应用

目的探讨多模式镇痛在达芬奇机器人辅助根治性膀胱全切除联合原位回肠新膀胱术中的应用价值。方法择期行达芬奇机器人辅助根治性膀胱全切除联合原位回肠新膀胱术中的患者60例,根据前后顺序分为2组(n=30),多模式镇痛组和对照组。多模式镇痛组的镇痛方案具体为:(1)帕瑞昔布钠的静脉使用;(2)腹横肌平面阻滞;(3)无阿片类药物的静脉镇痛泵。对照组只使用传统静脉镇痛泵。观察两组患者术后疼痛评分、镇痛相关不良反应发生率以及术后康复情况。结果 M组术后2 h、6 h、12 h、24 h、48 h疼痛评分明显低于对照组。多模式镇痛组术后恶心、呕吐、嗜睡、低血压发生率、追加止痛药及追加止呕药发生率均低于对照组。多模式镇痛组术后下床活动时间、排气时间、排便时间、住院时间明显早于对照组。结论多模式镇痛能有效减轻行达芬奇机器人辅助根治性膀胱全切除联合原位回肠新膀胱术患者的术后疼痛,促进早期下床活动,有利于患者术后康复,缩短住院时间。

Application of multimodal analgesia in Da Vinci robot-assisted radical cystectomy and orthotopic ileal neobladder

［Abstract］ Objective To explore the application value of multimodal analgesia in robot?assisted radical cystectomy and orthotopic ileal neobladder. Methods Sixty patients undergoing elective robot?assisted radical cystectomy and orthotopic ileal neobladder were divided into 2 groups（n=30）, multimodal analgesic group（group M）and control group（group C）. The analgesic strategy of group M were treated as follow：（1）Paracoxib sodium was used intravenously；（2）transverse abdominal plane block was performed；（3）no opioid patient controlled intravenous analgesia. The patients in group C were treated with conventional patient?controlled intravenous analgesia. The postoperative pain score, incidence of analgesia?related adverse reactions and postoperative rehabilitation of the two groups were collected and analyzed. Results The postoperative pain scores of 2 h, 6 h, 12 h, 24 h and 48 h in group M were significantly lower than those in C group. The incidence of nausea, vomiting, drowsiness, pruritus, hypotension, supplemental analgesics and additional antiemetic drugs in group M were lower than those in group Postoperative ambulation time, exhaust time, defecation time and hospitalization time in group M were significantly earlier than those in group C. Conclusion Multimodal analgesia can effectively alleviate postoperative pain of patients with radical cystectomy combined with orthotopic ileum and promote early bed removal by Da Vinci robot, which can help patients recover after operation and shorten the time of hospitalization.