才莹 崔轮盟 张虹

[摘要] 良好的镇痛及胃肠功能的早期恢复是重症监护病房（ICU）腹部术后患者康复的关键。随着当代医学的进步和中西医结合研究的不断深入，认识和治疗腹部术后疼痛的手段均有所提高。近年来，由于临床现有的镇痛方式带来的不良反应和局限性，中医镇痛因其操作便捷、副作用小，已迅速发展为世界主流医学的一部分，但因其对急危重患者疗效缓慢，且镇痛效果不能满足大、中型手术后的镇痛需求，故限制其在腹部术后危重症患者中的应用。通过中西医结合的多模式镇痛，二者相互配合，可达到有效的镇痛效果，并且能减少胃肠道相关不良反应的发生，调节机体应激状态，实现患者的快速康复。现就ICU腹部术后患者多模式镇痛的研究进展展开论述。

[关键词] 腹部手术;重症监护病房患者;多模式镇痛;中西医结合

[Abstract] Good analgesia and early recovery of gastrointestinal function is the key to the rehabilitation of patients after abdominal surgery in the intensive care unit （ICU）. With the progress of modern medicine and the deepening of integrated traditional Chinese and western medicine research， the methods of understanding and treating abdominal postoperative pain have been improved. In recent years， due to the limitation of adverse reactions （ADRs） caused by the existing clinical analgesic methods， traditional Chinese medicine（TCM） analgesia has rapidly developed into a part of the mainstream medicine in the world due to its convenient operation and small side effects. However， due to its slow efficacy on acute and critical patients and the fact that the analgesic efficacy cannot meet the analgesic needs of large and medium-sized surgery， its application in patients with critically illness after abdominal surgery has been limited. Therefore， through the multimodal analgesia of integrated traditional Chinese and western medicine， the cooperation of the two can not only achieve effective analgesic efficacy， but also reduce the occurrence of gastrointestinal related ADRs， regulate the body's stress state， and realize the rapid recovery of patients. The advances in multimodal analgesia for patients after abdominal surgery in ICU would be reviewed in this paper.

[Key words] Abdominal surgery; Patients in intensive care unit; Multimodal analgesia; Integrated traditional Chinese and western medicine

腹部术后患者遭受的疼痛为机体受到外科手术创伤后引起的一系列生理及心理上的反应，涉及机体多个系统及多层面的传导通路。术后的有效镇痛可以消除患者的疼痛及躯体不适感、减轻器官应激负荷、保护器官储备功能、维持机体内环境稳定，从而减少术后并发症的发生，加速患者快速康复。多模式镇痛（Multimodal analgesia，MMA）是指通过联合不同作用机制的镇痛药物和多种镇痛方法，阻断疼痛病理生理机制的不同时相和靶位，减少外周和中枢敏化，从而获得最佳疗效[1]。MMA已在重症医学中应用多年，并取得了较好的临床效果，其发挥的镇痛协同或相加作用，使之起效时间更快、维持时间更久，对腹部术后患者早期开展康复锻炼具有重要意义。……