[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"$f65-g5LTUgHIk8dGZIHhGe2pKpxnfW0g-O4HGxk3yxcs":3,"$f_PrFhi8cBXubmov4yS7BIoDLQTkLo-491ff95hn0oJI":8,"$ftmSziAtxtBEZFB6FPoJ92CsuhlZri40G3C3YGLg0goI":15,"$fozxLGNpePKNyzpUa0QmJMSr1QrL_W2RlZS4LeU8bhq4":21},{"code":4,"msg":5,"message":6,"data":6,"success":7},401,"认证失败，无法访问系统资源",null,false,{"code":9,"msg":10,"message":6,"data":11,"success":14},200,"操作成功",{"authors":12,"appraiseDimensionScoresVos":13},[],[],true,{"code":9,"msg":10,"message":6,"data":16,"success":14},{"pageNo":17,"pageSize":18,"result":19,"totalSize":20},1,10,[],0,{"code":9,"msg":10,"message":6,"data":22,"success":14},{"id":23,"specialistId":24,"specialistAssistants":25,"profilePhoto":26,"specialistName":27,"hospital":28,"department":29,"postsTitle":30,"materialTotal":31,"videoTotal":31,"isConcern":7,"title":32,"coverVertical":33,"coverAcross":34,"content":35,"description":36,"views":37,"likes":20,"isThumbsUp":7,"isCollection":7,"collections":20,"createTime":38,"seoTitle":32,"seoKeywords":39,"seoDescription":40,"shelvesTime":41,"version":31,"menus":42,"menuId":44,"type":17,"quality":61,"commentCount":20,"isComment":17},87620,1070706,[],"https://ystcdn.venuertc.com/venue/app/51462/2026-09-22/4d3030f8-41f9-475f-bee0-6391ce54425a.png","李子涵","大连沙河口中山公园联合路社区卫生服务中心","药剂科","初级药士",2,"实用指引｜高效应对术前术后疼痛：围手术期镇痛药物科学选用全攻略","","https://ystcdn.venuertc.com/venue/AI/4991041a-1e81-4b03-ae11-18f83df18d60.jpg","\u003Cdiv class=\"perioperative-pain-guide-container\">\n  \u003Ch1 id=\"material_title\" class=\"perioperative-pain-main-title\">\n    实用指引｜高效应对术前术后疼痛：围手术期镇痛药物科学选用全攻略\n  \u003C/h1>\n  \n  \u003Cdiv class=\"perioperative-pain-section\" style=\"background:linear-gradient(#f7fcff 90%,rgba(255,255,255,0.7) 100%);padding:20px 26px; border-radius:12px; margin-bottom:20px;\">\n    \u003Ch2 class=\"perioperative-pain-subtitle\">前言\u003C/h2>\n    \u003Cp class=\"perioperative-pain-text\">围手术期疼痛是外科常见急性疼痛，覆盖术前、术中、术后全过程。手术创伤引发的组织炎症、神经刺激与机体应激反应，不仅会造成躯体疼痛不适，还可诱发血压波动、免疫功能降低、术后恢复缓慢等问题，在一定程度上提升术后并发症的发生风险。规范、科学、个体化的镇痛药物选用，是围手术期医疗管理的重要内容，也是促进患者快速康复、提升诊疗质量与就医体验的关键。本文结合临床药事规范与诊疗共识，简要梳理围手术期镇痛药物分类、选用原则及安全用药要点，为临床合理用药提供参考。\u003C/p>\n  \u003C/div>\n  \n  \u003Cdiv class=\"perioperative-pain-section\" style=\"background:linear-gradient(#eafbf3 90%,rgba(255,255,255,0.7) 100%);padding:20px 26px; border-radius:12px; margin-bottom:20px;\">\n    \u003Ch2 class=\"perioperative-pain-subtitle\">一、围手术期镇痛核心理念✨\u003C/h2>\n    \u003Cp class=\"perioperative-pain-text\">现代围手术期镇痛摒弃了传统的被动止痛模式，以预防性镇痛、多模式镇痛、个体化镇痛为三大核心原则。预防性镇痛即在手术创伤前后提前干预疼痛传导，减轻术后疼痛峰值，降低机体疼痛敏化反应。多模式镇痛为临床主流方案，通过联合不同作用机制的镇痛药物，发挥协同镇痛效果，减少单一药物用量，降低药物不良反应。个体化镇痛需结合手术创伤大小、手术部位、患者年龄、肝肾功能、基础疾病等情况，动态调整用药方案，平衡镇痛效果与用药安全。有效的围手术期镇痛，可抑制创伤应激，稳定机体生命体征，助力患者早期下床、早期进食，缩短康复周期，减少急性疼痛转为慢性疼痛的可能性。\u003C/p>\n  \u003C/div>\n  \n  \u003Cdiv class=\"perioperative-pain-section\" style=\"background:linear-gradient(#fffbea 90%,rgba(255,255,255,0.7) 100%);padding:20px 26px; border-radius:12px; margin-bottom:20px;\">\n    \u003Ch2 class=\"perioperative-pain-subtitle\">二、围手术期常用镇痛药物分类及特点💊\u003C/h2>\n    \u003Cp class=\"perioperative-pain-text\">临床围手术期镇痛药物主要分为非阿片类、阿片类及辅助镇痛药物三类，各类药物临床特性差异显著，适配不同疼痛场景。\u003C/p>\n    \u003Ch3 class=\"perioperative-pain-label\">（一）非阿片类镇痛药\u003C/h3>\n    \u003Cp class=\"perioperative-pain-text\">该类药物为围手术期基础镇痛用药，无成瘾性，整体安全性较好，通过抑制炎症介质合成、阻断外周疼痛信号发挥作用，普遍存在镇痛天花板效应，不适用于重度疼痛单独镇痛。对乙酰氨基酚类药物镇痛退热效果稳定，抗炎作用较弱，对胃肠道、凝血功能影响较小，适用人群广泛，多用于轻中度围手术期疼痛，是多模式镇痛的基础配伍药物，临床需严控剂量，规避肝脏损伤风险。非甾体抗炎药镇痛抗炎效果更强，分为非选择性与选择性环氧合酶抑制剂。非选择性药物镇痛全面，但存在胃肠道刺激、影响血小板聚集等隐患，胃肠疾病、凝血异常患者需慎用；选择性药物胃肠安全性更高，对凝血功能影响小，更适配高龄、体质薄弱患者，肾功能异常人群需酌情调整用量。\u003C/p>\n    \u003Ch3 class=\"perioperative-pain-label\">（二）阿片类镇痛药\u003C/h3>\n    \u003Cp class=\"perioperative-pain-text\">阿片类为中枢性强效镇痛药，无明显镇痛天花板效应，主要用于术中镇痛及术后中重度急性疼痛控制。分为弱阿片类与强阿片类，弱阿片类不良反应较轻，适用于中度术后疼痛；强阿片类镇痛效果突出，多用于大型、创伤性手术后重度疼痛管理及术中镇痛。该类药物普遍存在恶心呕吐、头晕、便秘、尿潴留等不良反应，大剂量使用可能影响呼吸循环功能，不规范使用存在药物依赖风险，临床需遵循小剂量滴定、阶梯减量的用药原则。\u003C/p>\n    \u003Ch3 class=\"perioperative-pain-label\">（三）辅助镇痛药物\u003C/h3>\n    \u003Cp class=\"perioperative-pain-text\">此类药物单独镇痛作用有限，主要用于优化多模式镇痛方案。临床常用的NMDA受体拮抗剂可抑制中枢疼痛敏化，减少阿片类药物用量，预防慢性术后疼痛；α₂肾上腺素能受体激动剂兼具镇痛、镇静作用，可稳定术中血流动力学，缓解患者围手术期焦虑不适；抗惊厥类药物多用于神经源性术后疼痛的辅助治疗，改善顽固性疼痛症状。\u003C/p>\n  \u003C/div>\n  \n  \u003Cdiv class=\"perioperative-pain-section\" style=\"background:linear-gradient(#f7eaff 90%,rgba(255,255,255,0.7) 100%);padding:20px 26px; border-radius:12px; margin-bottom:20px;\">\n    \u003Ch2 class=\"perioperative-pain-subtitle\">三、镇痛药物分层选用原则🩺\u003C/h2>\n    \u003Cp class=\"perioperative-pain-text\">根据手术创伤程度与疼痛分级，临床实行分层镇痛用药方案，适配不同手术类型。 \n    \u003Cbr>轻度创伤手术如浅表肿物切除、微创介入手术等，术后疼痛轻微，以单一非阿片类药物预防性镇痛为主，术前常规给药，术后按需对症镇痛即可，无需联合用药，减少药物暴露风险。\n    \u003Cbr>中度创伤手术如普通腹部、骨科常规、乳腺甲状腺手术等，采用多模式镇痛方案，可选择两类非阿片类药物联用，或非阿片类联合弱阿片类药物。术前启动预防性镇痛，术中维持平稳镇痛，术后持续给药，兼顾镇痛效果与用药安全性，助力患者早期康复活动。\n    \u003Cbr>重度创伤手术如开胸、复杂腹腔、肿瘤根治、大型骨科手术等，创伤大、炎症反应重、术后疼痛剧烈，采用“非阿片类基础药+强阿片类药物+辅助镇痛药”三联方案。术前基础预处理，术中以强阿片类药物维持镇痛，术后逐步递减阿片类药物剂量，搭配辅助药物延续镇痛效果，疼痛缓解后阶梯式过渡为基础镇痛药物维持治疗。\n    \u003C/p>\n  \u003C/div>\n  \n  \u003Cdiv class=\"perioperative-pain-section\" style=\"background:linear-gradient(#eaf6ff 90%,rgba(255,255,255,0.7) 100%);padding:20px 26px; border-radius:12px; margin-bottom:20px;\">\n    \u003Ch2 class=\"perioperative-pain-subtitle\">四、特殊人群用药调整要点👨‍⚕️\u003C/h2>\n    \u003Cp class=\"perioperative-pain-text\">\n      高龄患者脏器功能、药物代谢能力生理性减退，耐受性较低，需遵循小剂量起始、缓慢滴定、按需给药原则，优先选用高安全性基础镇痛药，严控阿片类药物用量。\n      \u003Cbr>肝肾功能异常患者需根据脏器损伤等级调整方案，严控经肝代谢药物剂量，肾功能异常患者慎用非甾体抗炎药，优先选用对脏器影响较小的镇痛药物。\n      \u003Cbr>合并活动性胃肠疾病、消化道出血病史者，规避非选择性非甾体抗炎药，选用胃肠安全性更高的药物，必要时联合胃黏膜保护制剂。\n      \u003Cbr>存在慢性疼痛病史、长期服用镇痛药的患者，可优化多模式镇痛配比，增加辅助镇痛药物用量，合理调整主药剂量，规避药物耐受，保障镇痛效果。\n    \u003C/p>\n  \u003C/div>\n  \n  \u003Cdiv class=\"perioperative-pain-section\" style=\"background:linear-gradient(#eafff2 90%,rgba(255,255,255,0.7) 100%);padding:20px 26px; border-radius:12px; margin-bottom:20px;\">\n    \u003Ch2 class=\"perioperative-pain-subtitle\">五、安全用药核心规范⚖️\u003C/h2>\n    \u003Cp class=\"perioperative-pain-text\">\n      围手术期镇痛用药需坚守有效、安全、低风险的原则。一是落实标准化疼痛评估，动态调整用药方案，实现精准按需镇痛；二是优先采用多模式联合用药，降低单一药物剂量与不良反应风险；三是全程监测患者用药反应，及时处置胃肠不适、呼吸异常、肝肾功能波动等不良反应；四是规范用药疗程，术后疼痛缓解后逐步停药，避免长期冗余用药；五是坚持个体化用药，结合患者综合情况制定专属方案，杜绝统一化给药模式。\n    \u003C/p>\n  \u003C/div>\n  \n  \u003Cdiv class=\"perioperative-pain-section\" style=\"background:linear-gradient(#fffaf7 90%,rgba(255,255,255,0.7) 100%);padding:20px 26px; border-radius:12px; margin-bottom:12px;\">\n    \u003Ch2 class=\"perioperative-pain-subtitle\">总结📘\u003C/h2>\n    \u003Cp class=\"perioperative-pain-text\">\n      围手术期镇痛是外科快速康复体系的关键环节，合理选用镇痛药物可有效抑制创伤应激，降低并发症风险，加速患者术后康复。临床需严格遵循预防性、多模式、个体化镇痛理念，精准区分各类镇痛药物的适用场景，根据手术创伤等级、患者身体状况分层用药，同时严守用药安全规范，最大限度平衡镇痛疗效与用药安全。持续规范化开展围手术期镇痛用药管理，能够有效提升临床合理用药水平，优化整体诊疗效果，为患者安全快速康复提供保障。\n    \u003C/p>\n  \u003C/div>\n\u003C/div>\n\n\u003Cstyle>\n.perioperative-pain-guide-container {\n  font-family: \"Helvetica Neue\", Arial, \"PingFang SC\", \"Microsoft YaHei\", sans-serif;\n  max-width: 820px;\n  margin: 32px auto;\n  background: #fff;\n}\n.perioperative-pain-main-title {\n  text-align: center;\n  color: #006b53;\n  font-size: 2.1em;\n  background:linear-gradient(90deg,#b3e6e0 20%,#fff 80%);\n  border-radius: 11px;\n  padding: 22px 10px 17px 10px;\n  margin-bottom: 32px;\n  font-weight: 700;\n  letter-spacing: 0.02em;\n  box-shadow: 0 4px 24px rgba(180,210,210,0.10);\n}\n.perioperative-pain-section {\n  margin-bottom: 18px;\n  transition: box-shadow 0.33s;\n  box-shadow: 0 2px 10px rgba(190,210,220,0.04);\n}\n.perioperative-pain-subtitle {\n  font-size: 1.38em;\n  color: #2c6166;\n  font-weight: 600;\n  margin-bottom: 14px;\n  letter-spacing: 0.02em;\n  border-left: 7px solid #c3eedd;\n  padding-left: 14px;\n  background: rgba(189, 233, 216, 0.12);\n  border-radius: 5px;\n}\n.perioperative-pain-label {\n  font-size: 1.12em;\n  color: #167289;\n  font-weight: 500;\n  margin: 18px 0 8px 1px;\n  border-left: 4px solid #a8e2de;\n  padding-left: 10px;\n  background: rgba(200,230,230,0.07);\n  border-radius: 3px;\n}\n.perioperative-pain-text {\n  color: #353535;\n  font-size: 1.07em;\n  line-height: 2.05em;\n  margin-bottom: 0px;\n  text-align: justify;\n  letter-spacing: 0.01em;\n}\n@media (max-width:680px) {\n  .perioperative-pain-guide-container {padding: 0 5vw;}\n  .perioperative-pain-main-title {font-size: 1.32em; padding:11px 5px 11px 5px;}\n  .perioperative-pain-subtitle {font-size:1.05em; padding-left:8px;}\n  .perioperative-pain-label{font-size: 1em; padding-left:7px;}\n}\n\u003C/style>","\u003Cdiv class=\"perioperative-pain-guide-container\">\n  \u003Ch1 id=\"material_title\" class=\"perioperative-pain",1325,"2026-10-30 11:03:45","围手术期镇痛, 镇痛药物, 非阿片类药物, 阿片类药物, 辅助镇痛药物, 疼痛管理, 手术康复, 疼痛评估","本指南为您提供围手术期疼痛管理的科学选药全攻略，促进患者快速康复，降低并发症风险。了解镇痛药物分类、选用原则，确保安全有效用药。","2026-10-30 12:40:00",[43],{"menuId":44,"menuName":45,"parentId":20,"orderNum":31,"path":46,"component":47,"isFrame":48,"isCache":49,"menuType":50,"visible":17,"status":20,"createDept":6,"remark":33,"createTime":51,"children":52,"columnImage":53,"columnLogo":54,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":20,"forceLogin":20,"color":55,"seoTitle":56,"seoKeywords":57,"seoDescription":58,"contentNum":6,"promotionalPoster":59,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":60,"routerPath":46,"componentInfo":47},"1986713082609147906","健康科普","article","/article.html","1","0","T","2025-11-07 16:31:25",[],"https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:08:49/d4291d16-ed1c-48dd-84c8-ec1f85980b75.png","https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:08:52/6fe64094-9416-442c-a66d-032fb292666a.png","#c8e6ca","健康科普助力健康中国2030:共享健康知识新理念","健康科普, 健康中国, 科普知识, 健康家庭, 性健康, 营养健康, 运动健康, 科普宣传","探索健康科普在健康中国行动中的重要角色,了解最新的健康科普创新大赛、动漫及短视频,传播健康知识,助力全民健康。","https://ystcdn.venuertc.com/venue/undefined/2026-01-24-18:08:56/bd33f471-6c54-4d1b-a364-b06973dbc144.png","Article","重大疾病"]