围术期疼痛管理

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1、Perioperativepainmanagementofacutetochronicpainaftersurgery麻醉科弟子规骑下马乘下车过犹待百步余长者立幼勿坐长者坐命乃坐00IntroductionAcutePostoperativePainPersistentPostoperativePain123EpidemiologyDefinitionRiskfactors456PaintrajectoriesPreventionTreatment01EpidemiologyAcutePostoperativePainPersistentPostoperativePain公共卫生环境新

2、型镇痛药的发展是落后的阿片类药物是唯一一类广泛并成功使用的镇痛剂制药业不愿进一步开发新产品临床试验证明镇痛剂的功效的任务非常艰巨$2010年，美国FDA牵头组建了一个名为ACTION的团队，要求研究者以及企业对PPP的预防进行基础和临床研究。AnalgesicClinicalTrialInnovationsOpportunitiesNetworks启动和促进广泛的利益相关者的战略合作明确以共享数据，最佳实践和创新思维作为目的这些利益相关者将会贡献他们的资源来促进对话以及发展特殊项目，这样可以快速有效的进行镇痛药物的开发关键目的AND产业、学术界、专业组织、病人团体其他政府机构等数据、科

3、学技术、基础设施和金融资源TheACTIONcommitteehasmadesomerecommendationsforconductingclinicaltrialsforPPPprevention.ClinicaltrialsexaminingPPPneedtoincludepreoperative,intraoperative,andearlyandlatepostoperativeparametersandtheoutcomeneedstobeassessedatthedefinedtimepoint.02DefinitionPersistentPostoperativePai

4、nPersisitentpainaftersurgeryofgreaterthanthreemonthsduration.[IASP]PostoperativePersisitentPain（PPP）Timeframetwoorthreemonths?CausesLocationFunctionroleoutothercausesWhetheritistwomonthsorthreemonths?epidemiologicalandclinicaltrialsitisvitaltoselectaconservativetimeframeundergovariousclinicaltes

5、tstoruleoutotherpathologicalcausesTimeframetwoorthreemonths?CausesLocationFunctionroleoutothercausesinstabilityofthetibialfemoraljiontorpatellarmaltrackingESRCRPwhitebloodcellcountTimeframetwoorthreemonths?CausesLocationFunctionroleoutothercausestheoperatedsurgicalsiteTimeframetwoorthreemonths?C

6、ausesLocationFunctionroleoutothercausestheoperatedsurgicalsiteconsequencefromPPPonphysicalandsocialfunctionthedegreeofdisabilitydecreasehealthrelatedqualityoflifethecostoftreatmentcanbepredictedthevalueofpreventionwillbeappreciatedSOThecostfortreatmentofPPPandthedegreeofdisabilityfromPPParehigha

7、ndthereforeanymeasuresundertakentodecreasetheincidenceofPPPwillhaveasignificantimpactonthehealthcareresources.03RiskfactorsPersistentPostoperativePainPreoperativeriskfactorsIntraoperativeriskfactorsPostoperativeriskfactors31