【摘要】 目的探讨基于加速康复外科(fast track surgery,FTS)理念的围手术期多模式镇痛在腹腔镜胆囊切除术中的临床应用价值。方法回顾性搜集2013年7月至2015年7月期间在白银市第二人民医院普外科接受腹腔镜胆囊切除术的268例患者的临床资料,其中2014年8月31日之前的133例患者采用的传统围手术期镇痛方案(简称传统组),2014年9月1日之后的135例患者采用基于FTS理念的围手术期多模式镇痛(简称FTS组),比较2组患者的术后疼痛、肛门排气时间、排便时间、进食时间、下床活动时间、引流管留置时间、住院时间、72 h时的睡眠时间、并发症等情况。结果 1 FTS组患者术后1、4、8、12、24、48及72 h时的疼痛数字评估量表评分均明显低于传统组(P<0.01)。2 FTS组术后肛门排气、排便时间、进饮食时间、下床活动时间、引流管留置时间及住院时间均明显短于传统组(P<0.01),72 h时的睡眠时间明显长于传统组(P<0.01)。3 FTS组的恶心呕吐发生率明显低于传统组(P<0.01),其他不良反应如返酸、尿潴留及呼吸困难发生率在2组间比较差异无统计学意义(P>0.05)。4 FTS组术后镇痛效果满意率明显高于传统组(P<0.01)。结论在腹腔镜胆囊切除术围手术期采用基于FTS理念的多模式镇痛安全、有效,基本能够达到全程无痛的手术效果。更多还原

【Abstract】 Objective To study clinical value of perioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of fast track surgery(FTS). Methods The clinical data of 268 patients were analyzed retrospectively, who underwent laparoscopic cholecystectomy in the Department of General Surgery, the 2nd Hospital of Baiyin City from July 2013 to July 2015. All these patients were divided into FTS group and traditional group according to the chronological order, 133 patients in the traditional group were performed traditional perioperative analgesia before August 31, 2014, and 135 patients in the FTS group were performed perioperative multimodal analgesia method based on the concept of FTS after September 1, 2014. The data of both groups were collected and analyzed, including point of numerical rating scale, intestinal function recovery time, intake food time, ambulation time, drainage tube duration, postoperative hospital stay, postoperative sleep time at 72 h, and complications. Results(1) The points of numerical rating scale at 1 h, 4 h, 8 h, 12 h, 24 h, 48 h, and 72 h in the FTS group were significantly lower than those in the traditional group(P<0.01).(2) Compared with the traditional group, the intestinal function recovery time, intake food time, ambulation time, drainage tube duration, and postoperative hospital stay were obviously shorter, the postoperative sleep time at 72 h was obviously longer in the FTS group.(3) The incidence of nausea and vomiting in the FTS group was significantly lower than that in the traditional group(P<0.01), the incidences of the other complications such as acid reflux, urinaryretention, and breathing difficulty had no significant differences between these two groups(P>0.05). The satisfaction rate of postoperative analgesic effect in the FTS group was significantly higher than that in the traditional group(P<0.01). Conclusions Perioperative multimodal analgesia for laparoscopic cholecystectomy based on concept of FTS is safe and effective. It could achieve painless effect of laparoscopic cholecystectomy.更多还原