Chinese Medical Sciences Journal ›› 2017, Vol. 32 ›› Issue (3): 171-176.doi: 10.24920/J1001-9294.2017.024

• 论著 • 上一篇    下一篇

开腹肝切除手术中使用持续伤口置管镇痛模式的安全性和有效性

车璐1, 卢欣2, 裴丽坚1,*   

  1. 1 中国医学科学院 北京协和医学院 北京协和医院麻醉科,北京100730
    2 中国医学科学院 北京协和医学院 北京协和医院 肝脏外科,北京100730
  • 收稿日期:2017-02-05 出版日期:2017-09-27 发布日期:2017-09-27
  • 通讯作者: 裴丽坚

Efficacy and Safety of a Continuous Wound Catheter in Open Abdominal Partial Hepatectomy

Che Lu1, Lu Xin2, Pei Li-jian1,*   

  1. 1 Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2 Department of Hepatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2017-02-05 Published:2017-09-27 Online:2017-09-27
  • Contact: Pei Li-jian

摘要:

目的 研究在开腹肝切除手术的患者中使用伤口置管持续浸润镇痛的有效性和安全性。方法 本研究为前瞻非对照队列研究。计划实施开腹部分肝切除手术的患者在充分知情同意后自愿选择进入伤口置管持续浸润镇痛组(CWC),患者自控硬膜外镇痛组(PCEA),患者自控静脉吗啡组(PCIAM),和患者自控静脉舒芬组(PCIAS)。主要研究终点为术后4、12、24、48、72 h静息疼痛和活动疼痛的疼痛评分。次要研究终点为疼痛补救药物的使用,镇痛药物副作用和镇痛管理相关并发症的发生率。结果 在2013年8月至2013年12月期间,共有80例患者满足入组标准。10例患者进入了CWC组,22例进入PCEA组,29例进入PCIAM组,19例进入PCIAS组。在对年龄,性别,身体质量指数,肝切除比例,手术时间,阿姆斯特丹术前焦虑与信息量表评分等因素进行了矫正后,CWC组和PCEA,PCIAM,PCIAS各组间的静息疼痛和活动疼痛评分的差异在术后各个时间点无统计学意义 (P>0.05) 。CWC组在术后24、48和72 h对补救药物的需求和其他各组的差异无统计学意义(P>0.05)。CWC组术后恶心呕吐发生率和术后恢复排气时间与其他各组的差异无统计学意义(P>0.05)。所有研究入组的患者在研究期间未发生与持续伤口置管相关的并发症。结论 CWC与传统临床使用的术后镇痛模式比较,在镇痛效力方面无显著差异。对于开腹肝脏手术患者,CWC是一种安全的术后镇痛模式。

关键词: 伤口置管持续浸润镇痛, 术后疼痛, 部分肝切除术

Abstract: Objective

To investigate the efficacy and safety of continuous local anesthetic wound infiltration following open abdominal partial hepatectomy.

Methods

We performed a prospective, non-randomized, concurrent and controlled study. Patients undergoing open abdominal partial hepatectomy, according to their willingness, accepted one of the following managements for the postoperative pain: continuous wound catheter (CWC) infiltration, patient-controlled epidural analgesia (PCEA), patient-controlled intravenous analgesia of morphine (PCIAM), and patient-controlled intravenous analgesia of sufentanil (PCIAS). The primary outcome was postoperative visual analogue scale (VAS) scores at rest and on movement. Secondary outcomes included consumption of rescue medication, side effects, and complications associated with postoperative pain management.

Results

From August 2013 to December 2013, 80 patients were allocated to receive CWC (n=10), PCEA (n=22), PCIAM (n=29), or PCIAS (n=19). After adjusting for age, sex, body mass index, percentage of resected liver, operation time, and Amsterdam Preoperative Anxiety and Information Scale, there was no significant difference in the VAS scores at rest or on movement between Group CWC and the other groups, namely PCEA, PCIAM, and PCIAS, at 4, 12, 48, and 72 hours postoperatively (all P>0.05). The need for rescue medication was not significantly different between Group CWC and the other three groups at 48 and 72 hours postoperatively (all P>0.05). There was no significant difference in the incidence of postoperative nausea and vomiting or anal exsufflation time between group CWC and the other three groups (all P>0.05). No severe adverse effects associated with continuous wound infiltration were observed during the study period.

Conclusions

CWC has a comparable analgesic effect compared with traditional analgesia methods at most time points postoperatively. CWC is a safe alternative for the postoperative analgesic management of open liver surgery.

Key words: continuous wound catheter, postoperative pain, partial hepatectomy

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