發(fā)布時(shí)間：2018-03-07 02:00

  本文選題：腹腔鏡膽囊切除術(shù)　切入點(diǎn)：羅哌卡因　出處：《重慶醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 觀察腹腔鏡膽囊切除術(shù)（LC）患者膽囊三角內(nèi)應(yīng)用羅哌卡因的鎮(zhèn)痛效果及它對(duì)血漿皮質(zhì)醇、血糖水平的影響。 方法 將60例LC患者隨機(jī)分成2組，每組30例。實(shí)驗(yàn)組于術(shù)中在膽囊三角區(qū)注射羅哌卡因做局部浸潤(rùn)麻醉，對(duì)照組以等量生理鹽水做空白對(duì)照。記錄術(shù)后2h、6h、12h、24、48h視覺(jué)模擬評(píng)分（VAS）、舒適度評(píng)分及Ramsay鎮(zhèn)靜評(píng)分；于術(shù)前，術(shù)后6h、24h、48h抽取靜脈血測(cè)皮質(zhì)醇、血糖的濃度。 結(jié)果 兩組病例的基本情況無(wú)差異（P＞0.05）。實(shí)驗(yàn)組術(shù)后2h、6h、12h、24hVAS評(píng)分、鎮(zhèn)靜評(píng)分較對(duì)照組低（P＜0.05），舒適度評(píng)分較對(duì)照組高（P＜0.05）；術(shù)后48h實(shí)驗(yàn)組VAS評(píng)分與對(duì)照組比較無(wú)差異（P＞0.05），，但鎮(zhèn)靜評(píng)分仍較對(duì)照組低（P＜0.05），舒適度評(píng)分較對(duì)照組高（P＜0.05）。與術(shù)前值比，兩組術(shù)后6h、24h皮質(zhì)醇、血糖濃度均升高（P＜0.05），實(shí)驗(yàn)組術(shù)后第二天恢復(fù)到術(shù)前水平（P＞0.05），對(duì)照組仍高于術(shù)前（P＜0.05）。與對(duì)照組相比，術(shù)后6h、24h實(shí)驗(yàn)組皮質(zhì)醇及血糖濃度較低，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；術(shù)后48h兩組無(wú)明顯差異（P＞0.05）。 結(jié)論 于膽囊三角區(qū)注射羅哌卡因做局部浸潤(rùn)麻醉能減輕LC患者的術(shù)后疼痛，提高術(shù)后舒適度，并起到一定的鎮(zhèn)靜作用，同時(shí)減輕LC手術(shù)的應(yīng)激反應(yīng)，從而降低了LC術(shù)后患者血漿皮質(zhì)醇及血糖濃度。
[Abstract]:Purpose. To observe the analgesic effect of ropivacaine in cholecystectomy (LC) patients and the effect of ropivacaine on plasma cortisol and blood glucose levels. Method. Sixty patients with LC were randomly divided into two groups, 30 cases in each group. Ropivacaine was injected into the triangle of the gallbladder during the operation in the experimental group for local infiltration anesthesia. The visual analogue score (VAS), comfort score and Ramsay sedation score were recorded at 2 h and 6 h, 12 h and 24 h after operation, and the blood cortisol and blood glucose concentration were measured at 6 h and 24 h after operation. Results. There was no difference in the basic condition between the two groups (P > 0.05). The sedation score was lower than that in the control group (P < 0.05), the comfort score was higher than that in the control group (P < 0.05), the VAS score in the experimental group was not different from that in the control group (P > 0.05), but the sedation score was still lower than that in the control group (P < 0.05), and the comfort score was higher than that in the control group (P < 0.05). The concentration of cortisol in both groups increased at 6 hours and 24 hours after operation (P < 0.05), and recovered to the preoperative level at the second day after operation in the experimental group (P > 0.05), while that in the control group was still higher than that in the pre-operation group (P < 0.05). Compared with the control group, the concentration of cortisol and blood glucose in the experimental group at 6 hours and 24 hours after operation was lower than that in the control group. The difference was statistically significant (P < 0.05), but there was no significant difference between the two groups 48 hours after operation (P > 0.05). Conclusion. Injection of ropivacaine into the triangle of the gallbladder can relieve the postoperative pain, improve the comfort and sedation of patients with LC, and alleviate the stress reaction of LC. Thus, the plasma cortisol and blood glucose levels were decreased after LC.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R657.4

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