本文選題：羥考酮 + 舒芬太尼　； 參考：《延邊大學(xué)》2017年碩士論文

【摘要】：目的分析羥考酮和舒芬太尼對(duì)老年人結(jié)直腸癌根治術(shù)后的鎮(zhèn)痛效果的影響。探尋該兩種藥物對(duì)術(shù)后靜脈自控鎮(zhèn)痛的效果比較。方法選擇本院收治腹腔鏡根治術(shù)手術(shù)的老年結(jié)直腸癌患者80例分為A組和B組,每組40例。全部患者都選取全身麻醉方式進(jìn)行麻醉。術(shù)前均未使用鎮(zhèn)靜藥物,在全麻誘導(dǎo)時(shí),采用1.5-2 mg/kg丙泊酚、3-5 μg/kg芬太尼,0.1-0.12 mg/kg維庫溴銨這三種藥物,以期達(dá)到較好的麻醉效果。且在手術(shù)中,用微量泵泵注瑞芬太尼0.3ug/(kg.min)和丙泊酚4-12mg/(kg.h)、間斷補(bǔ)充維庫溴銨、持續(xù)吸入七氧醚讓老年患者維持麻醉狀態(tài)。機(jī)械通氣潮氣量設(shè)定為10 ml/kg,呼吸頻率為15～20次/分,吸呼比為1:2,監(jiān)測(cè)呼氣末二氧化碳分壓(PETC02),維持PETC02在35～45mmg。術(shù)畢將丙泊酚和瑞芬太尼停止泵注,待患者恢復(fù)自主呼吸以新斯的明(0.07mg/kg)配伍阿托品(0.2～0.4mmg)作為肌松拮抗劑以拮抗殘余的肌松作用,后將患者送入麻醉蘇醒室,所有患者均在蘇醒室內(nèi)拔除氣管導(dǎo)管。直到患者完全清醒且在不吸氧時(shí)血氧飽和度仍能大于95%超過5分鐘才可送返療區(qū)。A組鹽酸羥考酮30 mg;B組舒芬太尼100 ug,均溶于100 ml阿扎司瓊氯化鈉注射液中(阿扎司瓊10 mg),持續(xù)泵入劑量為每小時(shí)2 ml,單次PAC按壓追加劑量為2 ml,鎖定時(shí)間為15分鐘,鎮(zhèn)痛時(shí)間為48h。觀察兩組蘇醒后不同時(shí)間點(diǎn)(術(shù)后即刻為T0、2h為Tl、4h為T2、12h為T3、24h為T4)的VAS評(píng)分、Ramsay鎮(zhèn)靜評(píng)分、是否達(dá)到滿意鎮(zhèn)靜狀態(tài),并記錄48小時(shí)內(nèi)自控鎮(zhèn)痛泵追加鍵實(shí)際、有效按壓次數(shù),不良反應(yīng)的發(fā)生率。結(jié)果根據(jù)兩組比較觀察發(fā)現(xiàn),T0-T2時(shí)A組VAS評(píng)分較B組有明顯升高的現(xiàn)象,差異有統(tǒng)計(jì)學(xué)意義(P0.05)T3、T4均能達(dá)到滿意的鎮(zhèn)靜效果;T1-T4時(shí),B組Ramsay鎮(zhèn)靜評(píng)分明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)T2-T4時(shí)患者均能達(dá)到鎮(zhèn)靜滿意狀態(tài);48小時(shí)內(nèi),A組比B組PCA實(shí)際、有效按壓次數(shù)明顯增多,差異有統(tǒng)計(jì)學(xué)意義(P0.05);與B組比較,A組惡心、嘔吐、嗜睡發(fā)生率較低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。綜上所述,羥考酮和舒芬太尼都可以達(dá)到較好的術(shù)后鎮(zhèn)痛效果。結(jié)論羥考酮和舒芬太尼用于老年人結(jié)直腸癌腹腔鏡根治術(shù)后鎮(zhèn)痛是安全有效的,羥考酮不良反應(yīng)較少,適合臨床應(yīng)用。
[Abstract]:Objective to analyze the analgesic effect of hydroxycodone and sufentanil after radical resection of colorectal cancer in the elderly. To explore the effect of the two drugs on postoperative patient-controlled analgesia. Methods 80 elderly patients with colorectal cancer undergoing laparoscopic radical resection were divided into group A and group B with 40 cases in each group. All patients were anesthetized by general anesthesia. No sedatives were used before operation. In the induction of general anesthesia, the three drugs of propofol of 3-5 渭 g/kg fentanyl of 0.5 渭 g/kg 0.1-0.12 mg/kg of vecuronium bromide were used in order to achieve a better anesthetic effect. During the operation, remifentanil 0.3ugr / kg 路min and propofol 4-12 mg / kg 路h 路min were injected with micropump and vecuronium was added intermittently, sevooxyether was inhaled continuously to maintain anaesthesia in elderly patients. The tidal volume of mechanical ventilation was set at 10 ml / kg, the respiratory rate was 15 ~ 20 times / min, the ratio of inhalation and exhalation was 1: 2, the end expiratory partial pressure of CO _ 2 was monitored and PETC _ (02) was monitored, and the PETC02 was maintained at 35 ~ 45 mm / min. At the end of the operation, propofol and remifentanil were stopped by the pump, and the patients returned to spontaneous respiration with neostigmine (0.07mg / kg) and atropine (0.2mg / kg) as a muscle relaxant antagonist to antagonize the residual muscle relaxation, and then put the patient into the anaesthesia recovery room. All patients were removed tracheal catheter in the recovery room. Until the patient is fully awake and the saturation of blood oxygen can still exceed 95% more than 5 minutes without oxygen inhalation, he can not be returned to the treatment area. Group A is 30 mg of hydroxycodone hydrochloride, group B is sufentanil 100 ug.It is dissolved in 100 ml azasetron sodium chloride injection (Aza). Si Qiong 10 mg / h, continuous pump dose of 2 ml per hour, a single PAC compression dose of 2 ml, locking time of 15 minutes, The analgesia time was 48 hours. To observe the VAS score of sedation at different time points after waking up (T0 h 2 h, T 2 h 4 h, T 2 h 4 h, T 3 h 24 h, T 4), and to record the actual and effective times of pressing the additional key of the self-controlled analgesia pump within 48 hours, whether the score of Ramsay sedation was satisfactory to the sedative state, and to record the number of times of pressing the additional key of self-controlled analgesia pump within 48 hours. Incidence of adverse reactions. Results according to the comparison between the two groups, the VAS score of group A was significantly higher than that of group B at T0-T2, and the difference was statistically significant. The Ramsay sedation score of group B was significantly higher than that of group B at T1-T4. The difference was statistically significant at P0.05T2-T4. The patients in group A were more effective than group B in PCA within 48 hours, and the incidence of nausea, vomiting and lethargy in group A was lower than that in group B (P 0.05), and the incidence of nausea, vomiting and lethargy in group A was lower than that in group B. The difference was statistically significant (P 0.05). To sum up, both hydroxycodone and sufentanil can achieve better postoperative analgesia. Conclusion Hydrocodone and sufentanil are safe and effective for postoperative analgesia in elderly patients with colorectal cancer after laparoscopic radical operation.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614;R735.34

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