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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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

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	LI Songze HUANG Zeqing

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LI Songze HUANG Zeqing. Effects of different analgesic methods on chronic pain and sleep quality after abdominal surgery[J]. 中国医药导报, 2019, 16(13): 107-111.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2019/V16/I13/107

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