基础医学与临床 ›› 2022, Vol. 42 ›› Issue (12): 1900-1905.doi: 10.16352/j.issn.1001-6325.2022.12.1900

• 临床研究 • 上一篇    下一篇

胸科患者术后24 h内非计划停止自控静脉镇痛的原因分析

王境一1, 陈思1, 张越伦2, 王英丽3, 任立英3, 申乐1*   

  1. 中国医学科学院 北京协和医学院 北京协和医院 1.麻醉科; 2.医学科学研究中心; 3.手术室,北京100730
  • 收稿日期:2022-09-08 修回日期:2022-10-21 出版日期:2022-12-05 发布日期:2022-11-23
  • 通讯作者: * pumchshenle@aliyun.com
  • 基金资助:
    2020年国家重点研发计划(2020YFC2008401-1);北京协和医学院2020年中央高校教育教学改革专项(2020zlgc0105)

Reason analysis for unplanned discontinuation of patient-controlled intravenous analgesia after thoracic surgery

WANG Jing-yi1, CHEN Si1, ZHANG Yue-lun2, WANG Ying-li3, REN Li-ying3, SHEN Le1*   

  1. 1. Department of Anesthesia; 2. Medical Science Research Center; 3. Operating Room, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
  • Received:2022-09-08 Revised:2022-10-21 Online:2022-12-05 Published:2022-11-23
  • Contact: * pumchshenle@aliyun.com

摘要: 目的 分析胸科术后24 h内非计划停止使用患者自控静脉镇痛(PCIA)的影响因素,优化围术期镇痛方案,减少医疗资源浪费。方法 回顾性分析2018-04-01至2019-03-31在北京协和医院行胸科手术患者的临床资料。依据PCIA开始启用至结束时间将患者分为A组(≤24 h)及B组(>24 h)。采用单因素分析及多因素Logistic回归分析对比两组患者一般临床资料、麻醉/手术类型、PCIA配置方案及不良反应。结果 本研究共纳入371例患者。单因素分析中发现女性较男性患者24 h内停止术后PCIA比例更高(16.8%/39.4%);胸腔镜手术较开胸术后的患者24 h内停止术后PCIA的比例更高(31.4%/19.7%);PCIA中使用吗啡较羟考酮和舒芬太尼的患者更容易24 h内停止使用术后PCIA,而使用羟考酮较使用舒芬太尼的患者更容易24 h内停止使用PCIA(60%/40.5%/25.3%);PCIA中加入5-HT3受体阻断剂比未加入的患者24 h内停止使用术后PCIA的比例低(14.9%/30.6%);随访时患者呈镇静状态的患者比未存在镇静状态的24 h内停止使用PCIA的更少(25.3%/41.8%),主诉术后恶心的患者较无术后恶心者24 h内停止使用PCIA的比例更高(62.1%/17.3%),存在术后呕吐的患者较无术后呕吐者24 h内停止使用PCIA的比例更高(64%/22.1%)。Logistic多因素分析显示,女性、胸腔镜术式、术中吸入氧化亚氮、术后恶心呕吐是术后24 h内非计划停止PCIA的影响因素。结论 胸科患者使用PCIA进行术后镇痛应根据自身情况、手术类型、术后恶心呕吐风险进行全面评估,优化麻醉方式及药物选择,以加快术后康复,减少资源浪费。

关键词: 胸科手术, 术后急性疼痛, 患者自控静脉镇痛, 术后恶心呕吐

Abstract: Objective To analyze the impact factors for unplanned discontinuation of patient-controlled intravenous analgesia (PCIA) within 24 h after thoracic surgery so as to prevent over-use of medical resources. Methods Clinical data of patients with thoracic surgery in Peking Union Medical College Hospital from April 1, 2018 to March 31, 2019 were reviewed. Patients were divided into two groups according to the duration time from the start to the end of PCIA: group A(≤24 h) and group B(>24 h). Univariate analysis and logistic multivariate regression were used to compare the demographic characteristics, anesthesia/surgery type, PCIA regimen and adverse effect between the two groups. Results A total of 371 patients were included in this study. Univariate analysis showed that the proportion of patients stopped PCIA in 24 hours was higher in female patients than that in male patients (16.8%/39.4%). The proportion of PCIA stop in 24 hours after thoracoscopic surgery was higher than that after thoracotomy (31.4%/19.7%). In PCIA, patients who used morphine were more likely to stop using postoperative PCIA within 24 hours than those who used oxycodone and sufentanil, and patients who used oxycodone were more likely to stop using PCIA within 24 hours than those who used sufentanil (60%/40.5%/25.3%). The proportion of patients who stopped using 5-HT3 receptor blocker in PCIA within 24 hours was lower than that of those who did not (14.9%/30.6%). Patients who were of sedation at the time of follow-up were less likely to stop using PCIA within 24 hours than those who did not have sedation (25.3%/41.8%). Patients who complained of postoperative nausea were more likely to stop using PCIA within 24 hours than those who did not(62.1%/17.3%).The proportion of patients with postoperative vomiting who stopped using PCIA within 24 hours was higher than those without postoperative vomiting (64%/22.1%). Logistic multivariate analysis showed that female, thoracoscopic surgery, intraoperative inhalation of nitrous oxide, postoperative nausea and postoperative vomiting were related with unplanned discontinuation of PCIA within 24 h after thoracic surgery. Conclusions For patients undergoing thoracic surgery,the application of postoperative PCIA should be comprehensively evaluated according to the patient's personal situation, surgery type, and the risk of postoperative nausea/vomiting.

Key words: thoracic surgery, pain management, patient-controlled intravenous analgesia, postoperative nausea and vomiting

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