本文選題：胰十二指腸切除術(shù)　切入點(diǎn)：鎮(zhèn)痛方式　出處：《實(shí)用醫(yī)學(xué)雜志》2017年02期

【摘要】：目的:觀察胰十二指腸切除術(shù)(PD)后患者4種不同鎮(zhèn)痛藥物聯(lián)合使用的鎮(zhèn)痛效果,探究一種更加安全、有效、經(jīng)濟(jì)的鎮(zhèn)痛方式,分析相關(guān)鎮(zhèn)痛藥物導(dǎo)致的不良反應(yīng),有針對(duì)性地采取相應(yīng)護(hù)理措施。方法:回顧性選取普外科某手術(shù)組的PD術(shù)后患者412例,其中男262例,女150例,均采用全身麻醉和自控靜脈鎮(zhèn)痛(PCIA)方式,依據(jù)術(shù)后麻醉醫(yī)生采用的不同鎮(zhèn)痛藥物組合自然分為4個(gè)小組:組1(n=113)地佐辛+凱紛;組2(n=88)地佐辛+舒芬太尼;組3(n=105)諾揚(yáng)+凱紛;組4(n=106)舒芬太尼+凱紛。采用長海痛尺評(píng)價(jià)4種不同鎮(zhèn)痛藥物聯(lián)合的鎮(zhèn)痛效果,并觀察術(shù)后輔助用藥、胃管拔除時(shí)間、住院費(fèi)用、住院時(shí)間、不良反應(yīng)及并發(fā)癥發(fā)生情況。結(jié)果:4個(gè)小組的患者年齡、性別、體重、手術(shù)時(shí)間等一般資料差異均無顯著性(P0.05)。用長海痛尺評(píng)分在術(shù)后6 h差異有統(tǒng)計(jì)學(xué)意義(P0.05):兩兩比較,組2的評(píng)分最低(P0.05);其他時(shí)間段的評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后輔助用藥特耐和胃管拔除時(shí)間差異有統(tǒng)計(jì)學(xué)意義(P0.05),兩兩比較,組2的特耐使用率最低,胃管拔出時(shí)間最早。惡心嘔吐、瘙癢、腹瀉不良反應(yīng)和術(shù)后并發(fā)癥數(shù)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),均無尿潴留、呼吸抑制發(fā)生。結(jié)論:通過臨床觀察PD術(shù)后地佐辛聯(lián)合舒芬太尼藥物聯(lián)合的鎮(zhèn)痛效果更好。通過觀察不同鎮(zhèn)痛藥物的聯(lián)合使用,及時(shí)發(fā)現(xiàn)和處理可能出現(xiàn)的不良反應(yīng),以便減輕患者的痛苦和促進(jìn)患者康復(fù)。
[Abstract]:Objective: to observe the analgesic effect of combined use of four different analgesic drugs after pancreaticoduodenectomy (PDD), to explore a more safe, effective and economical analgesic method, and to analyze the adverse reactions caused by related analgesic drugs. Methods: 412 PD patients (262 males and 150 females) in a general surgery group were treated with general anesthesia and patient-controlled intravenous analgesia (PCIA). According to the different analgesic drug combinations used by the anesthesiologist after operation, they were divided into four groups: group 1 (n = 113), group 2 (n = 88), group 2) dizosin sufentanil; group 3 (n = 10 5); Group 4 (n = 10 6) sufentanil was used to evaluate the analgesic effect of four different analgesic drugs. The postoperative adjuvant medication, gastric tube extubation time, hospitalization cost and hospitalization time were observed. Results: there was no significant difference in age, sex, body weight, operation time and other general data among the 4 groups. The score of group 2 was the lowest (P 0.05), but the score of other time periods had no significant difference (P 0.05). There was a significant difference in postoperative adjuvant drug resistance and gastric tube extubation time (P 0.05), and the rate of special tolerance in group 2 was the lowest compared with that in group 2. There was no significant difference in the number of postoperative complications, such as nausea and vomiting, itching, diarrhea and postoperative complications. Conclusion: it is better to observe the analgesic effect of dizosin combined with sufentanil after PD. By observing the combined use of different analgesic drugs, we can find and deal with the possible adverse reactions in time. In order to alleviate the pain of patients and promote the recovery of patients.
【作者單位】： 中國人民解放軍第九二醫(yī)院精神科;長海醫(yī)院普外科;
【分類號(hào)】：R473.6

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