本文選題：術(shù)后疼痛　切入點(diǎn)：術(shù)后鎮(zhèn)痛　出處：《華中科技大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：目的：調(diào)查我院胃腸外科常規(guī)手術(shù)患者術(shù)后鎮(zhèn)痛效果,觀察局部浸潤麻醉在胃腸外科腹腔鏡手術(shù)中的輔助鎮(zhèn)痛作用,探索新型鎮(zhèn)痛模式。 研究對象：2013年3月至2013年9月我院胃腸外科出院手術(shù)病人；以及2013年10月至2014年2月胃腸外科單組收治的年齡大于18歲的胃、結(jié)直腸腫瘤患者需限期術(shù)治療者。 方法：采用問卷的形式調(diào)查140例隨機(jī)抽取的出院手術(shù)病人,分析統(tǒng)計(jì)患者住院期間疼痛與鎮(zhèn)痛效果以及出院后疼痛和整體鎮(zhèn)痛效果滿意度；臨床試驗(yàn)將52例入組病人隨機(jī)分成實(shí)驗(yàn)組(30)和對照組(22),實(shí)驗(yàn)組在腹腔鏡手術(shù)開始前,于手術(shù)部位腹膜外局部注射0.75%羅哌卡因(Ropivacaine)20ml,對照組不予相應(yīng)處理,術(shù)后觀察比較兩組間疼痛程度(VAS)、生命體征變化、不良反應(yīng)、下床、通氣、術(shù)后并發(fā)癥、術(shù)后住院時(shí)間及住院費(fèi)用等。 結(jié)果：問卷調(diào)查顯示,出院手術(shù)病人(119例)約52.9%(63例)能夠回憶起住院期間明顯的疼痛不適,平均NRS疼痛評分為4.68±1.12分；約73.9%(88例)患者認(rèn)為術(shù)后疼痛會影響自己早期下床,47.1%(56例)患者因?yàn)樘弁床辉缚人耘盘�；對住院期間鎮(zhèn)痛效果平均評分3.27±0.81分(滿分5分),其中有約47.9%(57例)評分在3分或以下。臨床試驗(yàn)中,實(shí)驗(yàn)組與對照組相比,患者術(shù)后1h、3h、6h、18h、36h和48h活動(dòng)狀態(tài)下疼痛程度VAS評分明顯降低,術(shù)后鎮(zhèn)痛相關(guān)不良反應(yīng)明顯減少,術(shù)后下床時(shí)間明顯提前；而對于術(shù)后PCA藥物用量、術(shù)后慢性疼痛、術(shù)后并發(fā)癥、術(shù)后住院時(shí)間及住院費(fèi)用無明顯影響。 結(jié)論：目前胃腸外科的術(shù)后鎮(zhèn)痛方法并不能很好的控制患者術(shù)后疼痛,還可能因此增加患者術(shù)后相關(guān)并發(fā)癥。而腹腔鏡手術(shù)前手術(shù)部位羅哌卡因腹膜外局部浸潤麻醉,在一定程度上可以幫助改善患者術(shù)后疼痛狀況,促進(jìn)早期下床活動(dòng),同時(shí)縮短住院時(shí)間,減少病人住院費(fèi)用。
[Abstract]:Objective: to investigate the effect of postoperative analgesia in patients undergoing routine gastrointestinal surgery in our hospital, to observe the auxiliary analgesic effect of local invasive anesthesia in laparoscopic operation of gastrointestinal surgery, and to explore a new mode of analgesia. Participants: patients with gastrointestinal surgery discharged from our hospital from March 2013 to September 2013, and patients with colorectal cancer who were treated in a single group of gastrointestinal surgery patients aged more than 18 years from October 2013 to October 2013. Methods: 140 randomly selected patients who were discharged from hospital were investigated by questionnaire, and the results of pain and analgesia during hospitalization, as well as the satisfaction of pain and overall analgesic effect after discharge were analyzed. 52 patients were randomly divided into experimental group (n = 30) and control group (n = 22). The experimental group was given 0.75% ropivacaine or ropivacaine20 ml at the site of operation before laparoscopy, and the control group was not treated accordingly. The degree of pain, vital signs, adverse reactions, getting out of bed, ventilation, postoperative complications, postoperative hospitalization time and hospitalization expenses were observed and compared between the two groups. Results: the questionnaire survey showed that there were 119 patients (52.9%) who were discharged from hospital. The average NRS pain score was 4.68 鹵1.12. About 73.9% of 88 patients thought that postoperative pain would affect their early exit from bed 47.1% and 56 cases) patients were unwilling to cough and discharge phlegm because of pain; The average score of analgesic effect during hospitalization was 3.27 鹵0.81 (with a full score of 5 and 57 cases). In the clinical trial, the VAS score of pain degree in the experimental group was significantly lower than that in the control group at 1 h, 3 h, 6 h, 18 h, 36 h and 48 h, respectively. Postoperative analgesia related adverse reactions were significantly reduced, and the time of getting out of bed was significantly earlier. However, there was no significant effect on postoperative PCA dosage, postoperative chronic pain, postoperative complications, postoperative hospital stay and hospitalization expenses. Conclusion: the current postoperative analgesia in gastrointestinal surgery can not control the postoperative pain, and may increase the postoperative complications. To some extent, it can help to improve the postoperative pain, promote the early activity of getting out of bed, at the same time shorten the hospitalization time and reduce the cost of hospitalization.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R614

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相關(guān)期刊論文 前1條

1 劉慧麗;馬彩虹;張小青;楊艷;宋雪凌;郭向陽;;宮-腹腔鏡檢查患者聯(lián)合應(yīng)用帕瑞昔布鈉和羅哌卡因?qū)πg(shù)后疼痛的影響[J];北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2013年06期

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本文編號：1569169