本文選題：舒芬太尼　切入點(diǎn)：超前鎮(zhèn)痛　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:將舒芬太尼術(shù)后鎮(zhèn)痛泵(patient-controlled intravenous analgesia,PCIA)超前應(yīng)用在行扁桃體(或聯(lián)合腺樣體)切除術(shù)的患兒中,觀察其在蘇醒期及術(shù)后48h內(nèi)的臨床效果及不良反應(yīng),同時(shí)與在手術(shù)結(jié)束時(shí)開(kāi)始應(yīng)用舒芬太尼鎮(zhèn)痛泵相比較,以探求維持小兒扁桃體(或聯(lián)合腺樣體)切除術(shù)圍拔管期穩(wěn)定的有效方法。方法:擬選擇在我院擇期行扁桃體(或聯(lián)合腺樣體)切除術(shù)的患兒60例,ASA I~II,隨機(jī)分為實(shí)驗(yàn)組和對(duì)照組,每組各30例。兩組患兒均接受全身麻醉。麻醉前準(zhǔn)備,麻醉誘導(dǎo)以及麻醉維持均相同。術(shù)中連續(xù)監(jiān)測(cè)患兒無(wú)創(chuàng)血壓(Non-invasive blood pressure,NIBP),心電圖(Electrocardiogram,ECG),心率(Heart rate,HR),脈搏血氧飽和度(Oxyhemoglobin Saturation by Pulse Oximetry,Sp O2),呼氣末二氧化碳分壓(Partial Pressure of End-tidal Carbon Dioxide,PETCO2)和腦電雙頻譜指數(shù)(Bispectral Index,BIS)。實(shí)驗(yàn)組(A組):手術(shù)結(jié)束前15min連接鎮(zhèn)痛泵進(jìn)行超前鎮(zhèn)痛;對(duì)照組(B組):手術(shù)結(jié)束時(shí)連接鎮(zhèn)痛泵進(jìn)行術(shù)后鎮(zhèn)痛。鎮(zhèn)痛泵中均加入舒芬太尼50ug和雷莫司瓊0.3mg用生理鹽水稀釋至100ml,設(shè)置背景速度為2ml/h,每次追加劑量為0.5ml,追加最小間隔時(shí)間為15min。兩組鎮(zhèn)痛泵均在使用48h后撤除。記錄入室時(shí)刻(T1)、拔管時(shí)刻(T2)、拔管后5min(T3)、拔管后10min(T4)、拔管后15min(T5)各時(shí)間點(diǎn)的MAP、HR、Sp O2;記錄手術(shù)時(shí)間(t1)、拔管時(shí)間(t2)以及出PACU的時(shí)間(t3)。觀察并記錄拔管后5min、10min、15min的PAED躁動(dòng)評(píng)分、Ramsay鎮(zhèn)靜評(píng)分及FLACC評(píng)分;觀察并記錄術(shù)后4h、8h、24h、36h VAS評(píng)分以及Ramsay鎮(zhèn)靜評(píng)分;觀察發(fā)生惡心、嘔吐、呼吸抑制、嗜睡和皮膚瘙癢等不良反應(yīng)的患者例數(shù)。結(jié)果:1、患者一般情況的比較:兩組患兒的年齡、身高、體重、手術(shù)時(shí)間相比差異無(wú)統(tǒng)計(jì)學(xué)意義;2、血流動(dòng)力學(xué)的比較:2.1組間比較:兩組患者各時(shí)間點(diǎn)的MAP、HR、Sp O2差異無(wú)統(tǒng)計(jì)學(xué)意義。2.2組內(nèi)比較:MAP、HR在拔管時(shí)(T2)明顯高于其他時(shí)間點(diǎn)(T1、T3、T4、T5),差異有顯著性(P0.05);拔管后三個(gè)時(shí)間點(diǎn)(T3、T4、T5)兩兩之間無(wú)顯著性差異;但拔管后的三個(gè)時(shí)間點(diǎn)(T3、T4、T5)與入室時(shí)(T1)相比,低于入室水平。Sp O2在拔管時(shí)(T2)低于其他時(shí)間點(diǎn)T1、T3、T4、T5),有顯著性差異(P0.05),其他時(shí)間點(diǎn)之間無(wú)顯著性差異;3、蘇醒指標(biāo)的比較:兩組患兒的拔管時(shí)間和出PACU的時(shí)間差異無(wú)統(tǒng)計(jì)學(xué)意義;4、蘇醒期躁動(dòng)和鎮(zhèn)靜評(píng)分比較:兩組患兒蘇醒期躁動(dòng)PAED評(píng)分、Ramsay鎮(zhèn)靜評(píng)分及FLACC評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05)。A組PAED評(píng)分、FLACC評(píng)分在T3、T4、T5低于B組;A組Ramsay鎮(zhèn)靜評(píng)分在T3、T4、T5高于B組;5、術(shù)后鎮(zhèn)痛以及鎮(zhèn)靜效果比較:術(shù)后4h、8h、24h、36h VAS評(píng)分以及Ramsay鎮(zhèn)靜評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義;6、發(fā)生不良反應(yīng)的比較:A、B兩組患者惡心、嘔吐、呼吸抑制、嗜睡、皮膚瘙癢發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1.舒芬太尼PCIA的超前鎮(zhèn)痛和正常術(shù)后鎮(zhèn)痛在小兒扁桃體(或聯(lián)合腺樣體)切除手術(shù)后起到同樣的鎮(zhèn)靜鎮(zhèn)痛作用;2.扁桃體(或聯(lián)合腺樣體)切除手術(shù)中,接受舒芬太尼PCIA超前鎮(zhèn)痛的小兒圍拔管期更穩(wěn)定。
[Abstract]:Objective: the postoperative sufentanil analgesia pump (patient-controlled intravenous analgesia, PCIA) in the application of advanced tonsillar (or combined adenoidectomy) resection in children, the clinical effects and adverse reactions were observed in the recovery period and within 48h after the operation, and at the same time started at the end of the operation application of sufentanil analgesia compared to to maintain the tonsillectomy (or combined adenoidectomy) effective method for resection of the extubation period stable. Methods: selected in our hospital undergoing tonsillectomy (or combined adenoidectomy) in 60 cases, resection of the children with ASA I~II, were randomly divided into experimental group and control group, 30 cases in each group. Two group the patients received general anesthesia. Preoperative preparation, anesthesia induced and maintained the same. Intraoperative continuous monitoring with non-invasive blood pressure (Non-invasive blood, pressure, NIBP), electrocardiogram (Electrocardiogram, ECG), heart rate (Heart, rate, HR), pulse Pulse oxygen saturation (Oxyhemoglobin Saturation by Pulse Oximetry, Sp O2), PetCO2 (Partial Pressure of End-tidal Carbon Dioxide, PETCO2) and bispectral index (Bispectral, Index, BIS). The experimental group (A group): the end of surgery for preemptive analgesia analgesia pump in 15min; the control group (B at the end of surgery group): analgesia for postoperative analgesia pump. The analgesia pump was added sufentanil 50ug and ramosetron 0.3mg diluted with normal saline to 100ml, set the background velocity is 2ml/h, each additional dose is 0.5ml, an additional minimum time interval for the 15min. two group were removed in the use of analgesia pump after 48h recorded before. Time (T1), extubation time (T2), 5min after extubation (T3), 10min after extubation (T4), 15min after extubation (T5) at different time points MAP, HR, Sp, O2; recording operation time (T1), extubation time (T2) and PACU time (T3) were observed and recorded. 鎷旂鍚，

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