黎燕玲 邓军

【摘要】 胆囊结石是一种常见的胆石病。腹腔镜胆囊切除术常用于治疗胆囊结石。加速康复外科对腹腔镜胆囊切除术后镇痛安全和舒适性提出了更高的要求。强阿片类（opioid）镇痛效果不容置疑，但同时也增加了术后呼吸抑制或延迟性呼吸抑制和术后恶心呕吐风险。多模式镇痛不仅能确保患者术后所必需的镇痛效果，同时也能最大程度减少opioid副作用，促进患者术后快速康复。

【关键词】 加速康复外科 多模式镇痛 腹腔镜胆囊切除术 阿片类

Research Progress of Multimodal Analgesia in Recovery Period after Laparoscopic Cholecystectomy under the Background of Enhanced Recovery after Surgery/LI Yanling， DENG Jun. //Medical Innovation of China， 2024， 21（14）： -184

[Abstract] Gallbladder stone is a common gallstone disease. Laparoscopic cholecystectomy is often used to treat gallbladder stone. Enhanced recovery after surgery puts forward higher requirements for analgesia safety and comfort after laparoscopic cholecystectomy. The analgesic effect of strong opioid is indisputable， but it also increases the risk of postoperative respiratory depression or delayed respiratory depression and postoperative nausea and vomiting. Multimodal analgesia can not only ensure the necessary analgesic effect of patients after surgery， but also minimize the side effects of opioid and promote the rapid recovery of patients after surgery.

[Key words] Enhanced recovery after surgery Multimodal analgesia Laparoscopic cholecystectomy Opioid

First-author's address： Postgraduate School， Youjiang Medical University for Nationalities， Baise 533000， China

doi：10.3969/j.issn.1674-4985.2024.14.042

胆囊结石（gallbladder stone，GBS）是常见的胆石病（gallstone disease，GSD）。GSD是一种常见消化系统疾病，影响全球约20%的人口[1-2]。腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）是治疗GBS常用的手术方式，手术切口小、并发症少、术后恢复快、住院时间短是LC的优点，但术后疼痛性质较复杂，术后恶心呕吐（postoperative nausea and vomiting，PONV）发生率较高[3]。大约10%的慢性术后疼痛（chronic post surgery pain，CPSP）是因控制不佳的急性术后疼痛（acute post surgery pain，APSP）转变而成[4]。强阿片类（opioid）镇痛不能满足加速康复外科（enhanced recovery after surgery，ERAS）对LC复苏的要求，难以把握术后镇痛与opioid不良反应的最优平衡。多模式镇痛（multimodal analgesia，MMA）能在确保术后所必需的镇痛前提下最大程度减少成瘾、中枢性呼吸抑制（延迟性呼吸抑制）、恶心、呕吐、便秘等opioid副作用，促进术后快速康复[5]。为此，本文就ERAS背景下术后复苏期MMA进行综述。

1 LC后复苏期疼痛现状研究

LC后复苏期APSP包括切口痛、内脏痛和牵涉痛等，同时也能诱发PONV[3]。研究发现，气腹期间高浓度二氧化碳吸收能刺激膈肌紧张或痉挛，后者使前列腺素合成增加，导致复苏期APSP尤其是术后炎性痛（post surgery inflammatory pain，PSIP）[3]。……