在心脏手术后的增强康复过程中,多种模式的止痛与腹平面阻断协议在心脏手术后的多种模式的止痛方案减少了阿片类药物的使用
Marc Darras1, Clément Schneider1, Sandrine Marguerite2
1Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
JTCVS open
|January 9, 2025
概括
手术后增强康复 (ERAS) 计划与多式联络止痛 (MMA) 和腹平面阻塞 (PPB) 显著增加了无阿片类药物率,并减少了心脏手术后的阿片类药物消费. 这种方法也改善了患者的治疗结果,并减少了并发症.
科学领域:
- 麻醉学和疼痛管理
- 心胸外科手术 心胸外科手术
- 手术重症监护手术重症监护
背景情况:
- 手术后增强恢复 (ERAS) 计划旨在优化患者的治疗结果,并减少大手术后的并发症.
- 多模式止痛 (MMA) 策略,包括阿片类药物节约方法,是ERAS协议的关键组成部分.
- 横侧平面阻塞 (PPB) 是一种区域麻醉技术,可以在胸部手术中提供有效的止痛.
研究的目的:
- 对接受选择性心脏手术的患者进行标准化ERAS计划的有效性进行调查,该计划将外科手术期间的MMA与阿片类药物节约策略和PPB结合起来.
- 评估这项ERAS计划对阿片类药物消费,疼痛控制和术后结果的影响.
主要方法:
- 一项对2015年至2021年接受选择性心脏手术的3153名患者的回顾性研究.
- 患者被分为具有和没有ERAS计划的组,包括MMA,阿片类药物节约方法和PPB.
- 倾向性得分匹配为分析创造了1026对匹配的对.
主要成果:
- 在重症监护室 (ICU) 的阿片类药物无毒率在ERAS组 (94.0%) 与对照组 (19.9%) 相比显著更高.
- 在ICU中的阿片类药物消费在ERAS组 (11.0MME) 与对照组 (31.0MME) 相比显著较低.
- 在ERAS小组中,机械通风持续时间减少,骨髓,妄,支气管肺炎的发生率降低,ICU停留时间缩短.
结论:
- 一个系统的,标准化的ERAS计划结合了MMA,一种阿片类药物节约策略和PPB,在大多数接受心脏手术的患者中有效地实现了无阿片类药物止痛.
- 这种综合方法显著降低了阿片类药物消费,并改善了手术后的结果,包括疼痛管理和并发症率.
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