多模式镇痛在OSAHS同期多平面手术后的应用

苏静; 田君海; 高欣欣; 吴永峰; 祖金美; 董凯峰; 段立广

doi:10.13201/j.issn.1001-1781.2018.11.012

多模式镇痛在OSAHS同期多平面手术后的应用

- 1. 河北医科大学第一医院耳鼻咽喉科(石家庄, 050031);
- 2. 河北医科大学第一医院药学部
基金项目:
河北省医学科学研究重点科技研究计划（No：20170495）

详细信息

通讯作者: 董凯峰,E-mail:36363977@qq.com

中图分类号: R563.8

收稿日期: 2018-01-21

Multimodal analgesic analgesia in patients with obstructive sleep apnea hypopnea syndrome with multiple planar surgery

- 1. Department of Otorhinolaryngology, the First Hospital of Hebei Medical University, Shijiazhuang, 050031, China;
- 2. Department of Pharmacy, the First Hospital of Hebei Medical University

More Information

Corresponding author: DONG Kaifeng, E-mail: 36363977@qq.com

Received Date: 21 January 2018

摘要

摘要: 目的：观察多模式镇痛在行同期多平面手术的OSAHS患者中的应用价值。方法：收集90例伴有舌体肥厚或者伴舌根淋巴组织增生的OSAHS患者，均同期行改良悬雍垂腭咽成形术及舌根部分切除术，或同时联合舌体消融术，随机分为2组，每组45例。多模式镇痛组于手术前0.5 h给予帕瑞昔布钠40 mg静脉注射，术后给予布地奈德氧气驱动雾化吸入治疗，术后24、48、72 h给予七叶皂苷钠10 mg入液静脉滴注；对照组不做上述处理。2组术后均予以40 mg帕瑞昔布钠静脉滴注，每日2次，疗程为4 d。对2组患者术后疼痛进行VAS评分，记录咽部黏膜消肿的时间及首次进食流食时间、并观察其术后恶心、呕吐等不良反应的发生情况。结果：2组患者年龄、性别、BMI、术中出血量、手术时间等比较均无统计学意义（P>0.05）；多模式镇痛组术后24、48、72、96 h VAS评分较对照组均下降明显，差异有统计学意义（P<0.05）；多模式镇痛组悬雍垂消肿时间及首次进食时间较对照组缩短明显，分别为（5.44±0.88）d和（7.68±0.89）d（t=12.01，P<0.01）；（30.1±7.3）h和（36.5±7.0）h（t=4.25，P<0.01）。结论：多模式镇痛应用于OSAHS患者同期多平面手术后镇痛效果肯定，有效降低了术后疼痛，缩短了术后消肿时间，提高了手术的依从性和安全性。
- 睡眠呼吸暂停低通气综合征,阻塞性 /
- 同期多平面手术 /
- 多模式镇痛
Abstract: Objective: To observe the value of multimodal analgesia in patients with OSAHS undergoing multiplanar surgery.Method: A total number of 90 patients with obstructive sleep apnea hypopnea syndrome with tongue hypertrophy or hyperplasia of the root lymphoid tissue were collected. All patients underwent improved uvulatopharyngeal angioplasty (H-UPPP) and tongue root partial resection, or simultaneous tongue ablation at the same time, and they were randomly divided into two groups, 45 patients in each group. In multi-modal analgesic group, the parrixibub sodium 40 mg were given intravenously 0.5 h before surgery, and oxygen budesonide aerosol inhalation therapy was given after surgery. Besides, sodium aescinate 10 mg was given intravenously 24, 48, 72 h after surgery, respectively. The control group did not do the above treatment. Both groups received 40 mg paradoxes sodium hydrostatic Bid for 4 days. To perform VAS on two groups of patients, uvula swelling time and first time to eat were recorded,and the symptoms of postoperative nausea and vomiting were observed. Result: The general conditions of the two groups of patients, including age, sex, body mass index, intraoperative blood loss, and operative time, were not statistically significant(all of the P>0.05). The scores of 24, 48, 72, 96 h VAS in multi-mode analgesic group were lower than those in control group after the operation of multi-mode analgesia, and the difference was statistically significant(P<0.05). The duration of the swelling time of the uvula in the multi-mode analgesic group was significantly shorter than that in the control group, and the difference was statistically significant (5.44±0.88) d compared with (7.68±0.89) d (t=12.01,P<0.01);(30.1±7.3)h compared with (36.5±7.0) h,(t=4.25,P<0.01).Conclusion: Multi-mode analgesia is effective for OSAHS patients after multi-planar surgery. It effectively reduces postoperative pain, shortened postoperative swelling time, and improves the surgical compliance and safety.
- sleep apnea hypopnea syndrome, obstructive /
- concurrent multiple plane surgery /
- multimodal analgesia

HTML全文

参考文献(22)

[1]	陈刚, 赵华, 温妮热, 等.重度阻塞性睡眠呼吸暂停低通气综合征的同期多平面外科治疗[J].临床耳鼻咽喉头颈外科杂志, 2011, 25(9):392-394.
[2]	王青云, 陈锐, 曹忠胜, 等.同期多平面手术对中-重度OSAHS患者血清氧化应激水平和认知功能的影响[J].临床耳鼻咽喉头颈外科杂志, 2015, 29(24):2139-2142.
[3]	GENG W, HONG W, WANG J, et al.Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential ExcisionSurgery[J].Mediators Inflamm, 2015, 2015:601083.
[4]	TOMITA A, SATANI M, MORIMOTO A, et al.Postoperative Analgesia in Peritonectomy for Patients with Peritoneal Surface Malignancy[J].Masui, 2015, 64:208-211.
[5]	陈焕琦, 张子恒, 周磊, 等.OSAHS患者围手术期应用西吡氯铵含片的疗效研究[J].临床耳鼻咽喉头颈外科杂志, 2017, 31(14):1123-1126.
[6]	赵晨, 王洪明, 马沂, 等.UPPP术后疼痛连续变化规律及应用氟比洛芬酯镇痛的临床研究[J].临床耳鼻咽喉头颈外科杂志, 2017, 31(7):504-509.
[7]	周旋, 李海红, 芦相玉, 等.右美托咪定复合芬太尼自控镇痛对肺癌切除术开胸患者机体免疫功能的影响[J].重庆医学, 2017, 46(A1):314-316.
[8]	朱剑宇, 荚卫东.围术期镇痛对肿瘤患者免疫功能影响的研究进展[J].国际外科学杂志, 2014, 41(12):845-849.
[9]	BARLETTA J F, ASGEIRSSON T, SENAGORE A J.Influence of intravenous opioid dose on postoperative ileus[J].Ann Pharmacother, 2011, 45:916-23.
[10]	张永燕, 许华.神经外科围术期多模式镇痛治疗研究进展[J].临床麻醉学杂志, 2017, 33(5):515-518.
[11]	张薇, 李卡, 张维汉, 等.多模式镇痛在胃癌患者根治手术中应用的前瞻性非随机对照研究[J].中华胃肠外科杂志, 2017, 20(3):270-276.
[12]	韩洁, 汪春英.多模式镇痛在乳腺癌围术期的应用[J].上海医学, 2016, 39(6):345-349.
[13]	邱敏, 付勤.脊柱后路手术多模式镇痛疗效分析[J].东南大学学报(医学版), 2016, 35(3):398-401.
[14]	王红仙, 陈陈, 胡月霞, 等.不同剂量舒芬太尼联合氟比洛酚酯在妇产科手术术后自控静脉镇痛的效果[J].安徽医药, 2016, 20(9):1756-1759.
[15]	梁粤, 李敬衡, 罗遥, 等.肺炎患儿应用布地奈德雾化吸入治疗的临床疗效研究[J].中华医院感染学杂志, 2016, 26(4):928-929, 935.
[16]	孔勇刚, 杨希林, 李新初.帕瑞昔布钠预防性用药对鼻内镜手术镇痛效果的研究[J].临床耳鼻咽喉头颈外科杂志, 2015, 29(16):1474-1476.
[17]	张立坤, 邵东风, 谷彬, 等.不同镇痛方式在悬雍垂腭咽成形术后镇痛的疗效比较[J].临床耳鼻咽喉头颈外科杂志, 2015, 29(11):991-993.
[18]	CUI W, YU X, ZHANG H.The Study of Different Approaches of Parecoxib Sodium Pretreatment on the Behavior of Rats with Neuropathic Pain[J].Cell Biochem Biophys, 2015, 72:137-140.
[19]	熊艳, 李海池, 彭银, 等.娑罗子中七叶皂苷类成分的最新研究进展[J].中药材, 2016, 39(5):1195-1199.
[20]	宋晓红, 王维皓, 陈世涛, 等.高效液相色谱-离子阱质谱分析七叶皂苷钠中的皂苷类成分[J].中国中药杂志, 2016, 41(13):2449-2454.
[21]	李存杰, 孙宇, 七叶皂苷钠联合小剂量泼尼松治疗亚急性甲状腺炎女性患者的疗效及安全性[J].山东大学耳鼻喉眼学报, 2016, 30(2):75-77, 83.
[22]	LI Q, OUYANG H, WANG P, et al.The antinociceptive effect of intrathecal escin in the rat formalin test[J].Eur J Pharmacol, 2012, 674:234-238.