不同镇痛方法对腹部手术后慢性疼痛和睡眠质量的影响

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摘要目的研究不同镇痛方法对腹部手术后慢性疼痛以及夜间睡眠质量的影响。方法选择2017年1月～2018年1月在中国医科大学肿瘤医院，辽宁省肿瘤医院进行腹腔手术的患者109例。本研究为回顾性研究，按照术后镇痛方法将患者分为硬膜外患者自控镇痛组（PCEA组）和超声引导下腹横纹肌平面（TAP）阻滞联合静脉内PCA（PCIA）组（PCIA+TAP组）。其中PCEA组50例，PCIA+TAP组59例。术后PCEA组留硬膜外导管进行PCEA，PCIA+TAP组进行TAP阻滞，并连接静脉镇痛泵。检测患者术后急性和慢性疼痛情况，睡眠质量和炎性因子水平。结果术后24 h，PCIA+TAP组患者视觉模拟评分（VAS）低于PCEA组（P ＜ 0.01），术后48 h，PCIA+TAP组VAS评分低于PCEA组（P ＜ 0.01）。PCIA+TAP组患者术后3个月术后慢性疼痛（CPSP）发生率明显低于PCEA组（P ＜ 0.05），VAS评分和ID Pain评分明显低于PCEA组（P ＜ 0.01）。术后48 h，匹兹堡睡眠质量指数量表（PSQI）评分≤7分的患者比例明显高于PCEA组（P ＜ 0.05），术后3个月PSQI评分≤7的患者比例明显高于PCEA组（P ＜ 0.05）。PCIA+TAP组患者术后24、48 h肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和IL-8水平均明显低于PCEA组患者（P ＜ 0.01），两组患者术后3个月TNF-α、IL-6和IL-8水平差异无统计学意义（P ＞ 0.05）。结论 TAP阻滞联合PCIA用于腹部手术术后急性疼痛镇痛效果佳，还能有效减轻患者CPSP，改善患者睡眠质量，提高患者生活质量。

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	李松泽黄泽清

关键词 ：慢性疼痛, 硬膜外, 超声引导, 腹横肌筋膜阻滞

Abstract：Objective To study the effects of different analgesic methods on chronic pain and nighttime sleep quality after abdominal surgery. Methods A total of 109 patients who underwent abdominal surgery in Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute from January 2017 to January 2018 were enrolled. This study was a retrospective study in which patients were divided into a patient-controlled epidural analgesia (PCEA) group and an ultrasound-guided transversus abdominis plane (TAP) according to postoperative analgesia. PCA (Patient-controlled intravenous analgesia, PCIA) group (PCIA + TAP group). There were 50 cases in the PCEA group and 59 cases in the PCIA+TAP group. Postoperative epidural catheters were performed in the PCEA group for PCEA, PCIA+TAP group for TAP, and a venous analgesia pump. Acute and chronic pain, sleep quality and inflammatory factor levels were measured after surgery. Results At 24 h postoperatively, the visual analogue scale (VAS) score was lower in the PCIA+TAP group than in the PCEA group (P ＜ 0.01). The VAS score in the PCIA+TAP group was lower than the PCEA group at 48 h after operation (P ＜ 0.01). The incidence of chronic pain (CPSP) in the PCIA+TAP group 3 months after operation was significantly lower than in the PCEA group (P ＜ 0.05). The VAS score and ID Pain score were significantly lower than those in the PCEA group (P ＜ 0.01). The proportion of patients with Pmtsburgh sleep quality index (PSQI) score ≤7 at 48 h after operation was significantly higher than that in PCEA group (P ＜ 0.05). The proportion of patients with PSQI score ≤7 was significantly higher 3 months after operation(P ＜ 0.05). The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-8 in the PCIA+TAP group 24，48 h after operation were significantly lower than those in the PCEA group(P ＜ 0.01). There were no significant differences in TNF-α, IL-6 and IL-8 levels 3 months after operation between two groups (P ＞ 0.05). Conclusion TAP combined with PCIA is effective for acute pain and analgesia after abdominal surgery. It can also effectively reduce postoperative CPSP, improve sleep quality and improve patients′ quality of life.

Key words： Chronic pain Epidural Ultrasound guidance Transverse abdominis fascia block

基金资助:辽宁省自然科学基金指导计划项目（201805502 18）。

引用本文:

李松泽黄泽清. 不同镇痛方法对腹部手术后慢性疼痛和睡眠质量的影响[J]. 中国医药导报, 2019, 16(13): 107-111.
LI Songze HUANG Zeqing. Effects of different analgesic methods on chronic pain and sleep quality after abdominal surgery. 中国医药导报, 2019, 16(13): 107-111.

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