目的::探讨融入快速康复外科( FTS)理念的多模式镇痛对胃肠道肿瘤病人的有效性、安全性、优越性及对IL-6的影响。方法:100例择期行胃肠道肿瘤根治术的病人按随机编号的方法分为两组,每组50例,A组为多模式镇痛组,B组为对照组,A组术前术后均给予非甾体抗炎药( NSAIDS)并行硬膜外自控镇痛( PCEA), B组采用传统镇痛模式,术毕硬膜外腔给予吗啡2mg,于术后2h、24h、48h比较两组病人舒适度( BCS评分)及静息和咳嗽时镇痛效果(VAS评分),并抽静脉血5mL检测IL-6水平;记录术后下床活动时间、肺炎发生率、住院时间及总费用。结果:A组病人术后24h、48h的视觉模拟评分(VAS评分)均低于对照组,差异有统计学意义(P<0.05);A组的满意度高于B组;24h、48h的IL-6水平A组显著低于对照组(P<0.05);A组术后早期下床活动时间、并发症、住院时间及总费用小于对照组(P<0.05)。结论:多模式术后镇痛可以显著减轻病人疼痛和应激反应,从而加快病人康复的速度,缩短住院时间,减少整体医疗消耗,促进医疗资源的合理利用,提高病人的舒适度。
Objective:Discussion into the fast track surgery( FTS) concept of multimodal analgesia efficacy,safety, superiority and its effect on gastrointestinal cancer patients on IL-6 production. Methods:100 patients undergoing elective gastrointestinal cancer radical surgery were randomly divided into two groups numbering method,50cases in each group,A group of multimodal analgesia in group B as the control group,both before and after surgery in group A given nonsteroidal anti-inflammatory drug (NSAIDS)parallel controlled epidural analgesia(PCEA),group B with traditional analgesic mode of surgery epidural morphine 2 mg,in after 2 h,24h,48h were compared patient comfort(BCS ratings)and rest and when coughing analgesia ( VAS score ) , and pumping blood 5 ml detect IL-6 levels;record postoperative ambulation time,the incidence of pneumonia and hospitalization time;Results:A group of patients 24 h,48h visual analog scale(VAS score)than the control group,the difference was statistically significant(P<0. 05);24h,IL-6levels in group A 48 h was significantly lower than the control group ( P<0. 05);A group of early postoperative ambulation,complications,length of stay and the total cost is less than the control group(P<0. 05);Conclusion:The multi-modal analgesia can significantly reduce pain and stress response, thus speeding up the rehabilitation of patients with speed, shorten hospital stays, reduce overall health care consumption and promote the rational use of medical resources, improve patient comfort.