快速康复理念下多模式镇痛在腹腔镜胆囊切除术中的应用研究

目的 探讨快速康复外科理念下多模式镇痛在腹腔镜胆囊切除术（LC）手术前后的应用及其对患者康复效果的影响。方法 按照随机数字表法将120例胆囊结石（n=82）或胆囊息肉（n=38）患者分成常规镇痛的对照组和快速康复外科理念下多模式镇痛的研究组,两组均60例。常规行LC手术,采用休斯顿疼痛情况调查表（HPOI）和匹兹堡睡眠质量指数（PSQI）分别进行疼痛和睡眠情况评估。应用SPSS 19.0统计学软件进行x²检验和独立样本的t检验。结果 研究组术后首次排气时间、首次排便时间、进食恢复时间、下床活动时间和总住院时间等围术期相关指标分别为（15.3±2.9） h、（30.6±4.3） h、（6.8±2.1） h、（4.8±1.4） h和（3.3±1.2） d,明显短于对照组【分别为（19.2±3.1） h、（45.2±5.3） h、（9.2±2.4） h、（7.2±1.6） h、（4.8±1.4） d,P<0.05】;术后12 h、24 h、72 h时,研究组疼痛程度评分结果分别为（6.3±1.6）分、（7.6±2.1）分和（8.3±2.4）分,明显高于同期对照组【分别为（4.4±1.3）分、（5.2±2.0）分和（6.5±2.1）分】;术后12 h、24 h、72 h时,研究组PSQI评分结果分别为（15.8±3.2）分、（13.4±2.8）分和（10.6±1.9）分,明显低于同期对照组【分别为（18.6±3.5）分、（17.5±3.2）分、（15.8±2.8）分,P<0.05】;研究组患者术后尿潴留、切口感染、下肢深静脉血栓形成发生率分别为3.3%、1.7%、6.7%,与对照组的5.0%、1.7%、10.0%比,无显著性统计学差异（P>0.05）。结论 将快速康复理念下多模式镇痛方案用于LC患者的临床治疗过程中,对缓解患者术后疼痛症状、改善睡眠质量、促进其康复具有积极的临床意义。

Application of multimodal analgesia under the idea of enhanced recovery after surgery in laparoscopic cholecystectomy

Objective To explore the application of multimodal analgesia under the idea of enhanced recovery after surgery in laparoscopic cholecystectomy（LC）. Methods 120 patients with gall stone（n=82） or gallbladder polyp（n=38） were recruited and divided randomly into routine analgesia （control group） and multimodal analgesia under the fast track surgery（study group）,with 60 cases in each group. The perioperative related indicators（postoperative duration of initial exhaust,duration of initial defecation, time of resumed eating,time of off-bed activities,total length of hospital stay） were compared between the two groups,and the pain scores was evaluated by Houston pain outcome instrument（HPOI） and the quality of life score by Pittsburgh sleep quality index（PSQI）. The incidence of postoperative complications was analyzed. Results The initial exhaust time,the initial defecation time,the time for feeding recovery,the ambulation time and the total hospital stay in the study group were（15.3±2.9） h,（30.6±4.3） h,（6.8±2.1） h,（4.8±1.4） h,（3.3±1.2） d,significantly shorter than （19.2±3.1） h,（45.2±5.3） h,（9.2±2.4） h,（7.2±1.6） h,（4.8±1.4） d] in the control（P<0.05）;at 12 h,24 h and 72 h after operation,the scores of pain in study group were （6.3±1.6）,（7.6±2.1） and （8.3±2.4）,significantly higher than （4.4±1.3）,（5.2±2.0） and （6.5±2.1）] in the control （P<0.05）,while the PSQI scores were （15.8±3.2）,（13.4±2.8）,（10.6±1.9）,significantly lower than （18.6±3.5）,（17.5±3.2）,（15.8±2.8）] in the control （P<0.05）;there was no significant difference between the two groups as respect to the incidence rates of postoperative urinary retention,incision infection and deep venous thrombosis（3.3%,1.7%,6.7% vs. 5.0%,1.7%,10.0%,respectively,P>0.05）. Conclusion The application of multimodal analgesia under the idea of enhanced recovery after surgery in the treatment of patients with gall stone or gallbladder polyp after LC is of importance in relieving postoperative pain,improving sleep quality,and promoting the recovery.