本文選題：術(shù)后體位　切入點(diǎn)：PONV　出處：《吉林大學(xué)》2014年碩士論文

【摘要】：研究背景：術(shù)后惡心嘔吐是麻醉及外科手術(shù)術(shù)后的常見并發(fā)癥，發(fā)生率各家報(bào)道不一，病人主訴術(shù)后惡心嘔吐帶來的不適比術(shù)后疼痛更為嚴(yán)重。關(guān)于預(yù)防術(shù)后惡心嘔吐的發(fā)生，國(guó)內(nèi)外學(xué)者也采用了很多方法，比如止吐藥和糖皮質(zhì)激素的應(yīng)用，穴位按壓等中醫(yī)方法，但是關(guān)于術(shù)后體位對(duì)惡心嘔吐的影響的研究尚甚少。 目的：觀察兩種不同體位對(duì)甲狀腺切除術(shù)后惡心嘔吐的影響。 方法：本實(shí)驗(yàn)為隨機(jī)、對(duì)照臨床實(shí)驗(yàn)。經(jīng)過吉林大學(xué)倫理委員會(huì)同意，術(shù)前患者均簽署知情同意書。選取吉林大學(xué)第一醫(yī)院2013年1月至2013年6月行擇期甲狀腺手術(shù)的女性患者400例，ASA分級(jí)I或II級(jí)，年齡18-65歲，無神經(jīng)系統(tǒng)疾病，無過敏史或過敏體質(zhì)者，術(shù)前一周內(nèi)未使用過止吐藥及糖皮質(zhì)激素類藥物，全部患者術(shù)后均不做自控鎮(zhèn)痛。擬行手術(shù)患者，隨機(jī)分為實(shí)驗(yàn)組（E組)和對(duì)照組（C組），每組各200例。E組術(shù)后始終低半臥位（頭肩部抬高30°左右），C組術(shù)后常規(guī)去枕平臥位6h后再墊枕。術(shù)前常規(guī)禁食水，均無術(shù)前用藥�；颊呷胧中g(shù)室后監(jiān)測(cè)無創(chuàng)血壓、心電圖、脈搏和血氧飽和度。兩組患者麻醉誘導(dǎo)、麻醉維持方法均相同。麻醉誘導(dǎo)采用咪達(dá)唑侖0.03－0.05mg/kg、芬太尼3－6ug/kg或舒芬太尼0.3－0.6ug/kg、順式阿曲庫銨0.1－0.2mg/kg、依托咪酯0.2－0.3mg/kg。去氮給氧5min后插入氣管導(dǎo)管。麻醉維持用丙泊酚4－12mg/kg/h，瑞芬太尼0.2－2ug/kg/h微量泵注。根據(jù)手術(shù)情況間斷給予順式阿曲庫銨0.05－0.1mg/kg。手術(shù)結(jié)束前15min常規(guī)靜脈給予昂丹司瓊4mg，術(shù)畢用新斯的明拮抗殘余肌松藥，患者意識(shí)清醒后，達(dá)到拔管指征后拔除氣管導(dǎo)管，患者送回病房繼續(xù)觀察，，吸氧6h。觀察患者有無PONV，術(shù)后2h、6h、12h和24h惡心、嘔吐、頭痛發(fā)生情況，止吐藥應(yīng)用情況及住院天數(shù)。 結(jié)果：惡心嘔吐主要發(fā)生在術(shù)后6－12小時(shí)左右。E組包括有暈動(dòng)史及有PONV史者術(shù)后惡心、嘔吐及頭痛等不適發(fā)生率低于C組（P0.05），止吐藥的用量、平均住院時(shí)間也低于C組（P0.05）。 結(jié)論：術(shù)后采用半臥位可降低PONV的發(fā)生率，減少止吐藥的應(yīng)用劑量、住院時(shí)間及住院費(fèi)用。
[Abstract]:Background: postoperative nausea and vomiting is a common complication of anesthesia and surgery.On the prevention of postoperative nausea and vomiting, domestic and foreign scholars have also adopted many methods, such as the use of antiemetic drugs and glucocorticoids, acupoint compression and other traditional Chinese medicine methods, but the effect of postoperatively on nausea and vomiting is still very little research.Objective: to observe the effect of two different postures on nausea and vomiting after thyroidectomy.Methods: this experiment is a randomized, controlled clinical trial.Prior to the approval of the ethics committee of Jilin University, informed consent was signed by the patients before operation.From January 2013 to June 2013, 400 female patients with ASA grade I or II, aged 18-65 years, with no neurological diseases, no history of allergies or allergic constitution, were selected from the first Hospital of Jilin University.No antiemetic drugs or glucocorticoids were used within one week before operation.Patients scheduled for operation were randomly divided into experimental group (group E) and control group (group C). Each group had 200 cases. Group E had a low supine position after operation (head and shoulder elevation of 30 擄or so) and group C routinely removed the occipital supine position for 6 hours after operation.There was no preoperative medication for routine fasting water before operation.Non-invasive blood pressure, electrocardiogram, pulse and oxygen saturation were monitored after entering the operating room.Anesthesia induction and maintenance were the same in both groups.Midazolam 0.03-0.05 mg / kg, fentanyl 3-6ug/kg or sufentanil 0.3-0.6 mg / kg, cis-atracurium 0.1-0.2 mg / kg, etomidate 0.2-0.3 mg / kg.The trachea catheter was inserted after nitrogen removal by oxygen supply 5min.Anesthesia was maintained with propofol 4-12 mg / kg / h, remifentanil 0.2-2ug/kg/h micropump.Cis atracurium 0.05-0.1 mg / kg / kg was given intermittently according to the operation conditions.At the end of operation, 15min was routinely given ondansetron 4 mg. After conscious consciousness, the patients got the indication of extubation and removed the trachea catheter. The patients were sent back to the ward for further observation and oxygen inhalation for 6 h.The incidence of nausea, vomiting, headache, antiemetic drug use and hospital stay were observed.Results: the incidence of nausea and vomiting in group E was lower than that in group C (6 to 12 hours after operation). The incidence of nausea, vomiting and headache in group E was lower than that in group C (P 0.05). The dosage of antiemetic drugs and the average hospital stay were also lower than those in group C (P 0.05).Conclusion: the use of semi-supine postoperatively can reduce the incidence of PONV, the dosage of antiemesis, the time of hospitalization and the cost of hospitalization.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 朱本氬;董長(zhǎng)明;;腰椎硬膜外聯(lián)合麻醉后護(hù)理體位的探討[J];重慶醫(yī)學(xué);2008年02期

2 陳濤;甲狀腺術(shù)后頭痛的原因淺析[J];中國(guó)臨床醫(yī)學(xué);2005年03期

3 魏其珍,趙艷,張燕,李莉,徐麗;普外科麻醉術(shù)后體位的觀察與處理[J];實(shí)用護(hù)理雜志;1998年06期

4 宋先榮;張咸虎;程學(xué)敏;;術(shù)后惡心嘔吐相關(guān)因素的臨床調(diào)查[J];中華全科醫(yī)學(xué);2008年07期

5 潘貽飛,施成飛;甲狀腺手術(shù)體位綜合征及預(yù)防[J];醫(yī)師進(jìn)修雜志;2002年10期

本文編號(hào)：1712851