目的: 探讨融入快速康复外科( FTS) 理念的多模式镇痛对胃肠道肿瘤病人的有效性、安全性、优越
性及对IL－6 的影响。方法: 100 例择期行胃肠道肿瘤根治术的病人按随机编号的方法分为两组，每组50 例，A
组为多模式镇痛组，B 组为对照组，A 组术前术后均给予非甾体抗炎药( NSAIDS) 并行硬膜外自控镇痛( PCEA) ，
B 组采用传统镇痛模式，术毕硬膜外腔给予吗啡2mg，于术后2h、24h、48h 比较两组病人舒适度( BCS 评分) 及静
息和咳嗽时镇痛效果( VAS 评分) ，并抽静脉血5mL 检测IL－6 水平; 记录术后下床活动时间、肺炎发生率、住院
时间及总费用。结果: A 组病人术后24h、48h 的视觉模拟评分( VAS 评分) 均低于对照组，差异有统计学意义( P
＜0．05) ; A 组的满意度高于B 组; 24h、48h 的IL－6 水平A 组显著低于对照组( P＜0．05) ; A 组术后早期下床活动
时间、并发症、住院时间及总费用小于对照组( P＜0．05) 。结论: 多模式术后镇痛可以显著减轻病人疼痛和应激
反应，从而加快病人康复的速度，缩短住院时间，减少整体医疗消耗，促进医疗资源的合理利用，提高病人的舒
适度。

Objective: Discussion into the fast track surgery( FTS) concept of multimodal analgesia
efficacy， safety， superiority and its effect on gastrointestinal cancer patients on IL－6 production．Methods:
100patients undergoing elective gastrointestinal cancer radical surgery were randomly divided into
two groups numbering method， 50cases in each group，A group of multimodal analgesia in group B as
the control group，both before and after surgery in group A given nonsteroidal anti－inflammatory drug
( NSAIDS) parallel controlled epidural analgesia( PCEA) ，group B with traditional analgesic mode of
surgery epidural morphine 2 mg， in after 2 h， 24h， 48h were compared patient comfort( BCS ratings) and
rest and when coughing analgesia( VAS score) ，and pumping blood 5 ml detect IL － 6 levels; record
postoperative ambulation time， the incidence of pneumonia and hospitalization time; Results: A group of
patients 24 h，48h visual analog scale( VAS score) than the control group， the difference was statistically
significant( P＜0．05) ; 24h， IL－6levels in group A 48 h was significantly lower than the control group( P
＜0．05) ; A group of early postoperative ambulation，complications， length of stay and the total cost is
less than the control group( P＜0．05) ; Conclusion: The multi－modal analgesia can significantly reduce
pain and stress response， thus speeding up the rehabilitation of patients with speed，shorten hospital
stays， reduce overall health care consumption and promote the rational use of medical resources，
improve patient comfort．

R493

 收稿日期: 2016－04－08; 修回日期: 2016－08－17
基金项目: 内蒙古自治区自然科学基金( 2015MS0832)
作者简介: 武丽芳( 1982－) ，女，内蒙古医科大学附属医院麻醉科主治医师。
通讯作者: 于建设，主任医师，E－mail: 22981506@ qq．com 内蒙古医科大学附属医院， 010050