2022 年第 6 期 第 17 卷

实时多模式疼痛管理策略防治颅脑手术后疼痛的效果及安全性

Effect and safety of real-time multimodal pain management strategy on the prevention and treatment of pain after craniocerebral surgery

作者：黄宇1孟岚2古丹1王涛3罗芳2

英文作者：Huang Yu1 Meng Lan2 Gu Dan1 Wang Tao3 Luo Fang2

单位：1首都医科大学附属北京天坛医院运营管理办公室，北京100070；2首都医科大学附属北京天坛医院疼痛科，北京100070；3首都医科大学附属北京天坛医院神经外科，北京100070

英文单位：1Department of Operating Management Office Beijing Tiantan Hospital Capital Medical University Beijing 100070 China; 2Department of Pain Management Beijing Tiantan Hospital Capital Medical University Beijing 100070 China; 3Department of Neurosurgery Beijing Tiantan Hospital Capital Medical University Beijing 100070 China

关键词：实时多模式疼痛管理；颅脑手术；手术后疼痛

英文关键词：Real-timemultimodalpainmanagement;Craniocerebralsurgery;Postoperativepain

• 摘要：

• 目的 评价实时多模式疼痛管理策略防治颅脑手术后疼痛的效果及安全性。方法 收集2020年2月至2021年9月首都医科大学附属北京天坛医院择期开颅手术的285例患者的临床资料行回顾性分析。根据疼痛管理策略的不同分为多模式镇痛组（97例，实施实时多模式疼痛管理策略）和对照组（188例，接受常规围术期镇痛）。通过倾向性评分（1∶1）邻近匹配法对2组患者进行匹配，比较2组患者术后第1、2、3天疼痛视觉模拟量表评分、术后镇痛药物使用量、围术期镇痛相关医疗费用、平均住院时间、镇痛相关并发症（恶心呕吐、头晕）的发生率。结果 倾向性评分匹配后，2组患者基线资料差异均无统计学意义（均P>0.05）。倾向性评分匹配后，多模式镇痛组术后第1、2、3天疼痛视觉模拟量表评分及术后氨酚羟考酮用量、平均住院时间明显低于/少于/短于对照组［（2.8±1.2）分比（3.7±1.4）分、（2.1±0.8）分比（2.3±0.9）分、（1.6±0.5）分比（2.0±0.8）分、（2.2±0.9）片比（3.8±1.2）片、（16±5）d比（18±3）d］，差异均有统计学意义（均P<0.05）。但2组患者术后镇痛泵舒芬太尼用量、镇痛相关医疗费用、镇痛相关并发症发生率差异均无统计学意义（均P>0.05）。结论 实时多模式疼痛管理策略镇痛效果明显，不增加围术期并发症的发生率。同时可缩短患者住院时间。

• Objective To evaluate the effect and safety of real-time multimodal pain management strategy on the prevention and treatment of pain after craniocerebral surgery. Methods The clinical data of 285 patients undergoing elective craniotomy in Beijing Tiantan Hospital, Capital Medical University from February 2020 to September 2021 were collected and analyzed retrospectively. According to different pain management strategies, they were divided into multimodal analgesia group(97 cases, implemented real-time multimodal pain management strategy) and control group(188 cases, received routine perioperative analgesia). The two groups were matched by propensity score (1∶1) proximity matching method. The scores of pain visual analogue scale score on the first, second and third days after operation, the dosage of postoperative analgesic drugs, perioperative analgesic expenses, average length of stay and the incidence of analgesic complications (nausea, vomiting and dizziness) were compared between the two groups. Results   After propensity score matching, there was no significant difference in baseline data between the two groups(all P>0.05). After the propensity score was matched, the pain visual analogue scale score in the first, second and third days after operation, dosage of oxycodone and acetaminophen, average length of stay in the multimodal analgesia group were significantly lower/less/shorter than those in the control group［(2.8±1.2) vs (3.7±1.4), (2.1±0.8) vs (2.3±0.9), (1.6±0.5) vs (2.0±0.8), (2.2±0.9)tablets vs (3.8±1.2)tablets, (16±5)d vs (18±3)d］(all P<0.05). However, there were no significant differences between the two groups in the dosage of postoperative analgesic pump sufentanil, analgesic expenses and the incidence of analgesic complications(all P>0.05). Conclusion  The real-time multimodal pain management strategy has obvious analgesic effect and does not increase the incidence of perioperative complications. At the same time, it can shorten the length of stay.