本文關(guān)鍵詞：星狀神經(jīng)節(jié)阻滯治療失眠癥的臨床觀察　出處：《蘇州大學》2015年碩士論文　論文類型：學位論文

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【摘要】：目的通過對選擇較低濃度的0.5%利多卡因行星狀神經(jīng)節(jié)阻滯治療失眠和口服艾司唑侖藥物治療失眠進行對比研究,以期為臨床上更為安全、有效地治療失眠癥提供新的臨床依據(jù)。方法根據(jù)《中國成人失眠診斷與治療指南》的診斷標準,選擇短期性失眠癥患者共40例,入組患者均無出血傾向及嚴重心血管疾病。隨機分成對照組(結(jié)合患者體重以及耐藥性情況,采用艾司唑侖每日睡前30分鐘1mg、2mg、4mg三種不同劑量口服,劑量標準以患者夜間睡眠能達到自我滿意程度的最小劑量為準)和治療組(選用較低濃度的0.5%利多卡因5ml行星狀神經(jīng)節(jié)阻滯)。二組治療均為每日一次,星狀神經(jīng)節(jié)阻滯為左右兩側(cè)交替進行,治療周期為10天,兩組患者均輔以相同的睡眠衛(wèi)生教育。治療前兩組患者均行匹茲堡睡眠質(zhì)量指數(shù)(PSQI)量表評測睡眠情況,治療結(jié)束后一月進行隨訪,復(fù)測PSQI量表。比較兩組患者治療前后PSQI量表七個組成因子的分值和總分的評分變化,以及睡眠時間的變化。因神經(jīng)阻滯的特殊性,治療組治療期間均采用心電監(jiān)護儀監(jiān)測患者心率、血壓、指末血氧飽和度。結(jié)果觀察1治療結(jié)果治療后兩組患者睡眠時間均有延長,睡眠質(zhì)量均有所提高。經(jīng)獨立樣本t檢驗分析,治療組在睡眠質(zhì)量、催眠藥物依賴性、白天功能紊亂以及PSQI總分方面均優(yōu)于對照組(P0.05),有統(tǒng)計學意義。2治療療效兩組患者年齡、性別、體重、治療時間等比較無明顯差異。治療前兩組患者PSQI量表評分無明顯差異。療效評估:①痊愈:PSQI總分為≤2,每晚平均睡眠時間6h,日間功能自我感覺良好。②顯效:PSQI為3~5分,每晚平均睡眠時間5~6h,日間功能感覺較好。③有效:PSQI為6~7分,睡眠時間4~5h,日間功能感覺尚可。④無效:與治療前無變化。隨訪結(jié)果表明:對照組治愈3例,顯效5例,好轉(zhuǎn)6例,無效6例,總有效率為70%;治療組治愈4例,顯效7例,好轉(zhuǎn)6例,無效3例,總有效率為85.0%,與對照組相比,經(jīng)卡方檢驗,無顯著性差異(P0.05)。因此,予0.5%利多卡因行星狀神經(jīng)節(jié)阻滯治療失眠可取得不亞于口服藥物的療效。在療效方面,治療組的有效率有提高的趨勢。統(tǒng)計學無明顯差異,可能與本實驗中樣本病例數(shù)量過少有關(guān)。3血流動力學治療組行神經(jīng)阻滯前后均應(yīng)用心電監(jiān)護儀監(jiān)測HR、BP、SPO2。結(jié)果表明,治療組患者在治療前后血流動力學指標均在正常波動范圍之內(nèi),阻滯前后數(shù)據(jù)經(jīng)配對t檢驗,無顯著性差異(P0.05)。結(jié)論1予0.5%利多卡因行星狀神經(jīng)節(jié)阻滯治療短期性失眠療效與口服藥物無明顯差異。予0.5%利多卡因行星狀神經(jīng)節(jié)阻滯治療能有效改善患者睡眠質(zhì)量,并改善患者日間功能。2予0.5%利多卡因行星狀神經(jīng)節(jié)阻滯對患者血流動力學無顯著影響,安全可靠。
[Abstract]:Objective to compare the choice of 0.5% lidocaine planetary ganglion block in the treatment of insomnia and oral eszolam in the treatment of insomnia in order to be more safe in clinic. Methods according to the diagnostic criteria of Chinese Adult Insomnia diagnosis and treatment guidelines, 40 patients with short-term insomnia were selected. All the patients in the study group had no tendency to bleed and severe cardiovascular disease. They were randomly divided into two groups: the control group (combined with the weight and drug resistance of the patients, 1 mg / day before sleep 30 minutes before sleep). Three different doses of 4 mg were taken orally. The dose standard was based on the minimum dose of self-satisfaction achieved by night sleep) and the treatment group (0.5% lidocaine 5ml planetary ganglion block at lower concentration). The two groups were treated once a day. Stellate ganglion block was performed alternately on the left and right sides and the treatment period was 10 days. The patients in both groups were given the same sleep hygiene education. Before treatment, the patients in both groups were assessed with Pittsburgh Sleep quality Index (PSQI) and followed up on January. Retest PSQI scale. Compare the scores of seven constituent factors and total score of PSQI scale before and after treatment, as well as the change of sleep time, because of the particularity of nerve block. In the treatment group, ECG monitor was used to monitor the heart rate, blood pressure and end-point oxygen saturation. Results 1 the sleep time of the two groups was prolonged after treatment. The sleep quality of the treatment group was better than that of the control group in terms of sleep quality, hypnotic drug dependence, daytime dysfunction and total score of PSQI (P 0.05). There were significant differences in age, sex and weight between the two groups. There was no significant difference in treatment time between the two groups before treatment. There was no significant difference in the scores of PSQI scale between the two groups before treatment. The total score of 1: 1 recovery was 鈮，

本文編號：1357393