在 laparoscopic 结直肠手术后增强康复的静脉内吗啡:一个随机临床试验
Liquan Zheng1, Yali Lu1, Xiaofan Lu1
1Department of Anesthesiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
腹腔内吗啡 (ITM) 与横向腹部平面阻断 (TAPB) 显著改善了腹腔镜直肠手术后的恢复质量和减少疼痛. 这种组合疗法提供了增强的止痛作用,但可能会增加风险.
科学领域:
- 麻醉学 麻醉学
- 术后恢复 术后恢复
- 疼痛管理 疼痛管理
背景情况:
- 手术后的疼痛仍然是腹腔镜结直肠手术中的挑战,阻碍了患者的康复.
- 最少侵入性技术提供恢复优势,但疼痛管理至关重要.
研究的目的:
- 评估内吗啡 (ITM) 与横腹平面阻断 (TAPB) 结合是否可以提高术后康复质量.
- 评估这种联合止痛方法在腹腔镜结直肠手术中的疗效.
主要方法:
- 一项前性,双盲随机临床试验,涉及252名接受腹腔镜结直肠手术的成年患者.
- 患者接受了ITM加TAPB与脂质体布皮瓦卡因或盐水安慰剂与TAPB.
- 主要结局是手术后24小时的康复质量15 (QoR-15) 评分.
主要成果:
- 在24小时内,ITM + TAPB组的QoR-15得分 (114.95) 与对照组 (102.22) 相比显著更高 (P < .001).
- 在干预组中,阿片类药物消费 (MME) 显著降低 (4.4 MME vs 10.4 MME;P < .001).
- 在ITM组中观察到恶心减少,但发病率较高 (19.0%与3.2%相比;P<.001).
结论:
- 结合TAPB的内吗啡显著改善了腹腔镜结直肠手术后的早期术后恢复和止痛.
- 这种多模式的方法可能是一个有价值的策略,以提高恢复,尽管的风险增加.
- 进一步的研究可以探索优化ITM剂量以减轻副作用,同时最大限度地提高益处.
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