本文選題：術(shù)后鎮(zhèn)痛 + 不同給藥模式��； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的本研究將通過對單膝關(guān)節(jié)置換術(shù)后PCA中芬太尼聯(lián)合曲馬多不同給藥模式，觀察其鎮(zhèn)痛效果，評價(jià)其安全性及有效性，探索安全有效的鎮(zhèn)痛模式,為臨床應(yīng)用提供參考資料。 方法擇行單側(cè)膝關(guān)節(jié)表面置換病人90例，性別不限，年齡50-70歲，排除各種原因不能采用腰麻完成手術(shù)的患者(如使用抗凝劑、脊柱畸形、強(qiáng)柱、類風(fēng)濕關(guān)節(jié)炎關(guān)節(jié)等)，隨機(jī)分為三組(A、B、C組)，，麻醉穿刺成功后5分鐘,手術(shù)開始前給藥并使用PCA泵(A組)；開始手術(shù)后給藥并使用PCA泵(B組)；A、B組給藥配方：（芬太尼0.1mg+曲馬多100mg稀釋入50ml液體，100ml/h恒速靜脈注射）；手術(shù)結(jié)束后使用PCA泵(C組)，PCA泵配方:芬太尼10ug/kg+曲馬多10mg/kg稀釋入100ml液體,背景劑量2ml/h，單次劑量0.5ml，鎖定時(shí)間15min，通過術(shù)后VAS評分，BCS舒適評分觀察患者術(shù)后3h.6h.9h.12h.24h鎮(zhèn)痛效果。 結(jié)果三組鎮(zhèn)痛效果VAS評分，BCS舒適評分組內(nèi)比較差異均無統(tǒng)計(jì)學(xué)意義（P0.05）。組間比較，VAS評分B組與A組五個(gè)時(shí)間點(diǎn)均無統(tǒng)計(jì)學(xué)差異（P0.05）；B組與C組在3h、6h和12h時(shí)間點(diǎn)具有統(tǒng)計(jì)學(xué)差異（P0.05）。BCS評分B組評分明顯高于A組、C組,B組與C組比較，3h，6h，9h，12h四個(gè)時(shí)間點(diǎn)差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后B組不良反應(yīng)發(fā)生率明顯低于A組、C組。 結(jié)論麻醉穿刺成功后5分鐘,開始手術(shù)后給藥并使用PCA泵(B組)；B組給藥配方：（芬太尼0.1mg+曲馬多100mg稀釋入50ml液體，100ml/h恒速靜脈注射）；，PCA泵配方:芬太尼10ug/kg+曲馬多10mg/kg稀釋入100ml液體,背景劑量2ml/h，單次劑量0.5ml，鎖定時(shí)間15min，通過術(shù)后VAS評分，BCS舒適評分觀察患者術(shù)后3h.6h.9h.12h.24h鎮(zhèn)痛效果與術(shù)前、術(shù)畢相比更為安全、有效，是值得推廣的術(shù)后PCA給藥模式
[Abstract]:Objective to observe the analgesic effect of fentanyl combined with tramadol in PCA after single knee arthroplasty, to evaluate its safety and effectiveness, to explore a safe and effective analgesic model, and to provide references for clinical application. Methods 90 patients with unilateral knee joint surface replacement, male and female, 50-70 years old, who could not be operated on by lumbar anesthesia without any reason (such as anticoagulant, spinal deformity, strong column) were selected. Patients with rheumatoid arthritis were randomly divided into three groups. Administration before operation and use of PCA pump group A; administration of drugs after operation and administration of PCA pump group B and PCA pump group B: (fentanyl 0.1mg tramadol 100mg diluted into 50ml liquid 100ml / h intravenously; PCA pump group C: PCA-PCA-PCA-Fentanyl, 0.1mg tramadol 100mg diluted into 50ml fluid 100ml / h; Fentanyl 0.1mg tramadol 100mg diluted into 50ml liquid 100ml / h intravenously; PCA pump group C Pump formula: fentanyl 10ug/kg tramadol 10mg/kg diluted into 100ml liquid, Background dose was 2 ml / h, single dose was 0.5 ml, locking time was 15 min. Postoperative 3h.6h.9h.12h.24h analgesia was observed by VAS score and comfort score. Results there was no significant difference in VAS score and comfort score between the three groups (P 0.05). There was no statistical difference in VAS score between group B and group A. There was statistical difference between group B and group C at the time points of 3h and 12h. The scores of group B were significantly higher than those of group A (group C) and group B (group B) were significantly higher than those of group A (group A, group C) at 3h, 6h, 9h, 12h, respectively. The point difference was statistically significant (P 0.05). The incidence of adverse reactions in group B was significantly lower than that in group A and C after operation. Conclusion five minutes after anesthesia puncture, the drug was given after the operation and the PCA pump was used in group B and group B was treated with Fentanyl 0.1mg tramadol 100mg diluted into 50ml liquid 100 ml / h intravenously: fentanyl 10ug/kg tramadol 10mg/kg was diluted into 100ml fluid. The results showed that Fentanyl 10ug/kg tramadol 10mg/kg was diluted into 100ml fluid, and Fentanyl 10ug/kg tramadol 10mg/kg was diluted into 100ml fluid. Background dose of 2 ml / h, single dose of 0.5 ml, locking time of 15 minutes. The analgesic effect of postoperative 3h.6h.9h.12h.24h was observed by VAS score and comfort score after operation. Compared with preoperative, the postoperative 3h.6h.9h.12h.24h analgesia was more safe and effective. It is worth popularizing the mode of postoperative PCA administration.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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