本文選題：羥考酮 + 芬太尼��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的：比較單次靜脈注射鹽酸羥考酮與芬太尼對(duì)腹腔鏡下行直腸腫物切除術(shù)患者術(shù)后急性疼痛及蘇醒質(zhì)量的影響。 方法：選擇擇期全身麻醉下行腹腔鏡直腸腫物切除術(shù)（不保肛）患者59例，ASA I-II級(jí)，男26例，女33例，年齡40-76歲。采用隨機(jī)數(shù)字表法，將其分為2組：鹽酸羥考酮注射液組（O組n=30）和芬太尼注射液組（F組n=29）。芬太尼組一名患者Prince-Henry評(píng)分達(dá)4分，追加鎮(zhèn)痛藥，提前退出試驗(yàn)。手術(shù)結(jié)束時(shí)給與羥考酮0.1mg/kg（生理鹽水稀釋為1mg/ml）或芬太尼1ug/kg（生理鹽水稀釋為10ug/ml）。當(dāng)患者恢復(fù)自主呼吸后，每分鐘呼喚患者一次，待患者意識(shí)清晰，反射活動(dòng)恢復(fù)后拔除氣管導(dǎo)管，拔管后吸入空氣，當(dāng)SpO2＜90%時(shí)，面罩吸氧（50%）并記錄。拔管后20min各組患者接鎮(zhèn)痛泵行PCIA。拔管即刻及拔管后5min，10min，15min及20min各時(shí)間點(diǎn)分別評(píng)定OAA/S鎮(zhèn)靜分級(jí)及術(shù)后疼痛Prince-Henry評(píng)分。當(dāng)OAA/S鎮(zhèn)靜分級(jí)為0級(jí)或Prince-Henry評(píng)分達(dá)4分時(shí)，病例剔除，不參與結(jié)果評(píng)定。記錄患者麻醉時(shí)間、手術(shù)時(shí)間、自主呼吸恢復(fù)時(shí)間、拔管時(shí)間和蘇醒時(shí)間(停藥到正確回答簡(jiǎn)單問(wèn)題)，記錄術(shù)畢即刻、拔管即刻及拔管后5min，10min，15min及20min的心率、SpO2和平均動(dòng)脈壓及各時(shí)間點(diǎn)評(píng)定的OAA/S鎮(zhèn)靜分級(jí)及術(shù)后疼痛Prince-Henry評(píng)分。 結(jié)果：兩組患者性別、年齡、體重及BMI、麻醉時(shí)間及手術(shù)時(shí)間比較，，差異無(wú)統(tǒng)計(jì)學(xué)意義。羥考酮組自主呼吸恢復(fù)時(shí)間、拔管時(shí)間及蘇醒時(shí)間均較芬太尼組短，差異有統(tǒng)計(jì)學(xué)意義(p＜0.05)。重復(fù)測(cè)量方差分析顯示：術(shù)畢即刻到拔管后20分鐘期間，羥考酮組心率，平均動(dòng)脈壓變化趨勢(shì)與芬太尼組一致。兩組術(shù)后急性疼痛均有緩解，但各時(shí)間點(diǎn)芬太尼組Prince-Henry鎮(zhèn)痛評(píng)分均高于羥考酮組，且術(shù)后急性疼痛發(fā)生例數(shù)較羥考酮組多（7:2）；OAA/S鎮(zhèn)靜分級(jí)均低于羥考酮組，術(shù)后鎮(zhèn)靜過(guò)度例數(shù)亦較羥考酮組多（9:1）；血氧飽和度下降幅度較羥考酮組大，SpO2≤90%發(fā)生例數(shù)較羥考酮組多（5:1），面罩吸氧后均改善。惡心及嘔吐等副作用的發(fā)生率兩組相似，無(wú)統(tǒng)計(jì)學(xué)差異。 結(jié)論：手術(shù)結(jié)束時(shí)單次靜脈注射羥考酮0.1mg/kg比靜脈注射芬太尼1ug/kg能更好的預(yù)防腹腔鏡下行直腸腫物切除術(shù)患者術(shù)后急性疼痛的發(fā)生，且鎮(zhèn)靜及呼吸抑制等副作用更小，全麻蘇醒期應(yīng)用更安全。
[Abstract]:Aim: to compare the effects of single intravenous administration of hydroxone hydrochloride and fentanyl on postoperative acute pain and recovery quality in patients undergoing laparoscopic rectal tumor resection. Methods: a total of 59 patients (26 males and 33 females, aged 40-76 years) with ASA grade I-II were selected for laparoscopic rectal mass resection under elective general anesthesia. The rats were randomly divided into two groups: hydroxy coxone hydrochloride injection group (n = 30) and fentanyl injection group (n = 29). One patient in fentanyl group had a Prince-Henry score of 4, added analgesics and quit the trial ahead of time. At the end of the operation, they were given 0.1 mg / kg of hydroxycodone (diluted to 1 mg / ml of saline) or 1 mg / kg of fentanyl (diluted to 10 mg / ml of saline). When the patient returned to spontaneous breathing, he called to the patient once a minute. When the patient's consciousness was clear, the reflex activity was recovered, the trachea catheter was removed, and the air was inhaled after the extubation. When SpO2 < 90, the mask inhaled oxygen 50% and recorded. After extubation, the patients in 20min group were treated with analgesic pump. OAA/S sedation grade and postoperative pain Prince-Henry score were evaluated immediately after extubation, 10 min after extubation and 15 minutes after extubation and at each time point of 20min. When the OAA/S sedation grade was 0 or the Prince-Henry score was 4, the cases were eliminated and the results were not evaluated. Time of anesthesia, operation, recovery of spontaneous respiration, extubation and recovery were recorded. Heart rate SpO2, mean arterial pressure, OAA/S sedation grade and postoperative pain Prince-Henry score were evaluated immediately and 5 min after extubation and 20min. Results: there was no significant difference in sex, age, body weight, BMI, anesthesia time and operation time between the two groups. The time of spontaneous respiration recovery, extubation and recovery in hydroxycodone group was shorter than that in fentanyl group (P < 0.05). Repeated analysis of variance showed that the change trend of heart rate and mean arterial pressure in hydroxycodone group was the same as that in fentanyl group between immediately after operation and 20 minutes after extubation. The Prince-Henry analgesia score of fentanyl group was higher than that of hydroxycodone group at each time point, and the incidence of postoperative acute pain was higher than that of hydroxycodone group, and the sedation grade of acute pain was lower than that of hydroxycodone group, and the sedation score of fentanyl group was lower than that of hydroxycodone group. The number of cases of hypersedation after operation was 9: 1, the decrease of blood oxygen saturation was more than that of hydroxone group, the incidence of SPO 2 鈮

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