外科手术后改善康复 (ERAS) 的外科手术期间胺和胺:一个系统性审查
Muhan Xu1, Rongjie Zhu2, Yong-Jun She3
1Department of Anesthesiology and Pain Research Center, Jiaxing University College of Medicine, Jiaxing, China.
在外科手术后的胺和胺有效地减少了手术后的疼痛和阿片类药物使用,在手术后增强恢复 (ERAS) 协议中. 这些药物还对抑郁症状和睡眠质量有好处,尽管需要对认知影响进行更多的研究.
科学领域:
- 麻醉学和外科手术期间的医学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 手术后增强恢复 (ERAS) 协议简化了外科手术期间的护理,以加快患者的恢复.
- 胺和胺越来越多地被纳入ERAS战略,以改善患者的治疗结果.
研究的目的:
- 在ERAS中系统地审查有关外科手术期间使用胺和胺胺的证据.
- 评估对术后疼痛,阿片类药物消费,恶心/吐,认知功能,抑郁和睡眠质量的影响.
主要方法:
- 随机对照试验的系统审查,元分析,系统审查和临床指南.
- 使用推评估,开发和评估 (GRADE) 框架对证据进行分级.
主要成果:
- 胺/胺持续降低术后疼痛和阿片类药物消耗 (手术后24-48小时).
- 这两种药物都能减少早期的术后抑郁症状,特别是在患有抑郁症的患者中.
- 适度的证据支持esketamine对术后恶心/吐和睡眠质量 (72h内) 的好处.
- 对于术后神经认知障碍的影响,证据不足.
结论:
- 术后的胺和胺是ERAS多模式止痛药的宝贵补充,有助于抑郁和睡眠障碍.
- 限制包括异质性,小样本大小和短的随访时间;最佳剂量需要进一步研究.
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