Zhang Hanwen,Liu Haonan,Li Duoyi,et al.Perioperative multimodal analgesia in children with congenital spinal deformities[J].Journal of Clinical Pediatric Surgery,2025,(11):1051-1055.[doi:10.3760/cma.j.cn101785-202206030-011]
儿童先天性脊柱畸形患者围手术期多模式镇痛应用研究
- Title:
- Perioperative multimodal analgesia in children with congenital spinal deformities
- Keywords:
- Analgesia; Spinal Deformity; Surgical Procedures; Operative; Child
- 摘要:
- 目的 评价围手术期多模式镇痛方案对儿童先天性脊柱畸形患者的疼痛干预效果,总结临床经验。方法 本研究为前瞻性研究,将2020年9月至2021年5月于首都医科大学附属北京儿童医院接受脊柱后路截骨矫形植骨融合内固定术的80例儿童先天性脊柱畸形患者作为研究对象。其中男27例、女53例,年龄(6.53±3.03)岁,美国麻醉医师协会分级2(1,2)级。应用随机数表法将患者分为观察组(n=40)和对照组(n=40)。观察组采用多模式镇痛方案进行围手术期疼痛管理,主要包括超前镇痛、术毕局部浸润麻醉和术后镇痛药联用,对照组采用传统围手术期疼痛管理模式。分别于术前、术后6 h、术后1~3 d每日上午9时、下午3时、晚间8时记录患儿疼痛评分,对比两组患儿疼痛评分、总住院时间、术后住院时间和并发症发生率等指标。结果 80例均顺利完成手术,术前无一例畸形相关疼痛发生。术后3 d内两组患儿疼痛评分均呈下降趋势,其中观察组患儿疼痛评分明显低于对照组。术后第2天、第3天对照组疼痛波动较观察组更明显。术后3 d内观察组和对照组分别有12例、35例患儿疼痛评分>3分,差异有统计学意义(P<0.001)。观察组和对照组分别有2例(2.5%)和6例(15.0%)患儿发生并发症,差异无统计学意义(P=0.263)。观察组和对照组总住院时间分别为(13.05±2.81)d和(14.70±2.51)d,术后住院时间分别为(6.33±0.80)d和(6.90±1.30)d,差异均有统计学意义(P<0.05)。结论 对儿童先天性脊柱畸形患儿围手术期应用多模式镇痛方案可有效减轻患儿疼痛,缩短住院时间,促进其快速康复,值得临床推广应用。
- Abstract:
- Objective To evaluate the effectiveness of perioperative multimodal analgesia regimen in pain management for children with congenital spinal deformities (CSD) and summarize the relevant clinical experiences. Methods For this prospective study,the clinical data were retrospectively reviewed for 80 CSD children undergoing posterior spinal osteotomy,corrective fusion and internal fixation from September 2020 to May 2021.The cohort consisted of 27 boys and 53 girls with a mean age of (6.53±3.03) year and an ASA grade of 2(1,2).They were randomized into two groups of experimental (n=40) and control (n=40).Experimental group received a multimodal analgesia cpmbining preemptive analgesia,postoperative local infiltration anesthesia,and postoperative analgesic dosing.Control group was managed with traditional perioperative pain-relieving.Pain scores were recorded at pre-operation,6h post-operation and postoperative days 1-3 at 9:00 AM,3:00 PM and 8:00 PM.Outcomes,including pain scores,total hospitalization stay,postoperative hospitalization stay and complication rates were compared between two groups. Results All operations were successfully completed without preoperative deformity-related pain.Pain scores for both groups declined over the first three postoperative days.Experimental group had significantly lower scores as compared with control group.At post-operation Day 2/3,pain fluctuations were more pronounced in control group.At Day 3,12 children (30%) in experimental group and 35 cases (87.5%) in control group had pain scores >3.There was statistically significant difference (P<0.001).The incidence of complications was 2.5% (n=2) in experimental group and 15.0% (n=6) in control group.There was no statistically significant difference (P=0.263).The most common complications were mild abdominal pain or bloating in both groups.Total hospitalization stay for experimental and control groups was (13.05±2.81) and (14.70±2.51) day while postoperative hospital stay (6.33±0.80) and (6.90±1.30) day.There were statistically significant differences (P<0.05). Conclusions Using a multimodal analgesia regimen in perioperative management of CSD children may effectively alleviate pain,shorten hospitalization stay and accelerate postoperative recovery.Wider clinical popularization is worthwhile.
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备注/Memo
收稿日期:2023-6-13。
基金项目:新疆维吾尔自治区重点研发任务专项项目(2023B03018—2)
通讯作者:姚子明,Email:docyao@mail.ccmu.edu.cn