圍術期靜脈輸注利多卡因?qū)π乜剖中g病人術后鎮(zhèn)痛效果的研究
發(fā)布時間：2019-02-13 14:49
【摘要】：研究背景：疼痛是一種由組織損傷或者潛在的組織損傷所引起的不愉快的感覺或情感體驗。手術后的疼痛是一種在手術后即刻發(fā)生的急性的疼痛，是臨床上常見的，，需要及時進行處理的癥狀。 在各種類型的外科手術中，胸科術后的疼痛尤為劇烈，這也成為了患者懼怕胸科手術的最主要原因之一。術后疼痛的主要原因有：肋間神經(jīng)、肌肉韌帶以及切口的創(chuàng)傷和胸腔引流管對機體造成的刺激等。手術后的疼痛會直接影響呼吸運動的幅度和咳嗽排痰的過程，造成呼吸道內(nèi)分泌物大量潴留，繼而可能引發(fā)肺不張、胸腔積液、胸腔感染等，情況嚴重者甚至可能會造成呼吸衰竭和死亡。因此及時而有效合理的鎮(zhèn)痛不僅能夠改善術后患者的呼吸功能，減少術后并發(fā)癥的發(fā)生，而且還可以促進病人從手術的打擊中盡快恢復。目前在臨床上使用的經(jīng)靜脈患者自控鎮(zhèn)痛(PCIA)方法，是胸科術后患者中應用最廣泛有效的術后鎮(zhèn)痛方法之一，但單一的鎮(zhèn)痛方法往往不能夠達到理想的鎮(zhèn)痛效果，因此使用兩種或兩種以上的鎮(zhèn)痛方法進行復合鎮(zhèn)痛日益成為趨勢。硬膜外鎮(zhèn)痛是目前公認的胸科術后鎮(zhèn)痛的金標準，但是其并發(fā)癥、禁忌癥和不良反應在一定程度上限制了該方法在臨床上的應用。本文研究的是在胸科手術患者的圍術期，靜脈輸注利多卡因進行超前鎮(zhèn)痛以后，觀察胸科術后患者經(jīng)靜脈患者自控鎮(zhèn)痛(PCIA)的鎮(zhèn)痛效果。 目的：在胸科手術患者的圍術期靜脈輸注利多卡因，進行超前鎮(zhèn)痛以后，觀察病人術后經(jīng)靜脈患者自控鎮(zhèn)痛（PCIA）的鎮(zhèn)痛效果以及對病人術后康復的影響。 方法：選擇全麻下進行胸科手術的病人120例，隨機將其分為2組（n=60）。A組（利多卡因?qū)嶒灲M），用藥為利多卡因、芬太尼、舒芬太尼、地佐辛、雷莫司瓊。B組（對照組），用藥為芬太尼、舒芬太尼、地佐辛、雷莫司瓊。A、B兩組病人均進行術后自控靜脈鎮(zhèn)痛（PCIA）。所有病人統(tǒng)一手術方法和麻醉方法，兩組均采用全憑靜脈麻醉。術中、術后按各組鎮(zhèn)痛方法進行鎮(zhèn)痛。經(jīng)靜脈患者自控鎮(zhèn)痛（PCIA）藥物為舒芬太尼100ug、地佐辛150mg、雷莫司瓊0.6mg，用生理鹽水稀釋至100ml。然后由另一名不知道分組情況的麻醉醫(yī)生運用視覺模擬評分法（VAS）來評價病人術后1h、4h、8h、24h、48h、72h的鎮(zhèn)痛效果（包括靜息、咳嗽時的VAS評分），記錄PCIA按壓的次數(shù)，不良反應，術后并發(fā)癥，生命體征，鎮(zhèn)靜、惡心、嘔吐的評分和人數(shù)。 結果： ⒈鎮(zhèn)痛評分結果(VAS評分)：在相同時間段兩組之間相互比較，（1）靜息時的VAS評分，術后1h、4h、8h，A組的鎮(zhèn)痛評分與B組有顯著差異，有統(tǒng)計學意義（P0.05）；術后24h、48h、72h, A組的鎮(zhèn)痛評分與B組無顯著差異，無統(tǒng)計學意義（P0.05）；（2）咳嗽時的VAS評分，術后1h、4h、8h、24h，A組的鎮(zhèn)痛評分與B組有顯著差異，有統(tǒng)計學意義（P0.05）；術后48h、72h， A組的鎮(zhèn)痛評分與B組無顯著差異，無統(tǒng)計學意義（P0.05）。 2.追加鎮(zhèn)痛藥物的比較：兩組之間各個時間段相互比較，術后1h、4h、8h、24h的按壓次數(shù)比較，Ｂ組明顯多于Ａ組（P0.05），有統(tǒng)計學意義（P0.05）。術后48h、72h的按壓次數(shù)比較，Ａ組和Ｂ組無顯著差異（P0.05）。 3.術后咳嗽、咳痰配合能力的比較：A組患者能夠更好的配合咳嗽咳痰，將呼吸道內(nèi)分泌物排出，Ａ組優(yōu)于B組。 4.未觀察到有關利多卡因的嚴重不良反應。 5.兩組患者的Ramsay鎮(zhèn)靜評分，術后1h、4h、8h，B組的鎮(zhèn)靜評分明顯低于A組，有統(tǒng)計學意義（P0.05），B組患者鎮(zhèn)靜效果較差。其余時間段兩組患者的鎮(zhèn)靜評分無顯著差異（P0.05）。 6.兩組病人術后鎮(zhèn)痛的滿意度：A組患者術后疼痛刺激較小，A組的滿意度優(yōu)于B組。 結論：在胸科手術的圍術期靜脈輸注利多卡因，進行超前鎮(zhèn)痛以后，能夠增強術后PCIA的鎮(zhèn)痛效果，有效緩解術后疼痛，同時減少了術后并發(fā)癥的發(fā)生，并且沒有觀察到有關利多卡因的嚴重不良反應，可以安全有效地應用于胸科手術患者。
[Abstract]:Study Background: Pain is an unpleasant feeling or emotional experience caused by tissue damage or potential tissue damage. The post-operative pain is an acute pain that occurs immediately after the procedure, which is clinically common and requires a timely treatment. In various types of surgery, the pain in the thoracic surgery is particularly acute, which has also become the main cause of the patient's fear of the thoracic surgery. I. The primary cause of post-operative pain is the trauma of intercostal nerves, muscle ligaments, and the trauma of the incision and the stimulation of the body. and the like, and the pain after the operation can directly influence the amplitude of the breathing motion and the process of the cough and the sputum, so that the secretion of the secretion in the respiratory tract can be retained, and then the lung can not be caused, the pleural effusion, the chest infection and the like can be caused, and the severe person can even cause the respiratory failure and the death Therefore, the timely and effective and reasonable analgesia can not only improve the respiratory function of the patients after operation, reduce the occurrence of postoperative complications, but also promote the recovery of the patient from the operation of the operation as soon as possible. Complex. The method of self-controlled analgesia (PCIA), which is currently used in clinical use, is one of the most effective and effective methods for postoperative analgesia in patients with thoracic surgery, but a single analgesic method often does not achieve the desired analgesic effect. As a result, the use of two or more analgesic methods for compound analgesia is increasingly becoming the general trend Potential. Epidural pain is a well-recognized standard for postoperative analgesia, but its complications, contraindications and adverse reactions limit the clinical application of this method to a certain extent. In this paper, the analgesic effect of the postoperative patient-controlled analgesia (PCIA) in the patients with thoracic surgery was observed after the perioperative and intravenous injection of lidocaine in the patients with thoracic surgery. Objective: To observe the analgesic effect of the patient-controlled analgesia (PCIA) and the postoperative rehabilitation of the patients after the intravenous infusion of lidocaine in the perioperative period of the patients with thoracic surgery. Methods: 120 patients who underwent thoracic surgery under general anesthesia were randomly divided into two groups (n = 60). A group (group A of lidocaine) was used as lidocaine, fentanyl, sufentanil and zizine. in group B (control group), remifentanil, sufentanil, zizine, The postoperative self-controlled intravenous analgesia was performed in both groups of patients in the group A and B. PCIA). All patients have a unified surgical method and a method of anesthesia, both of which are all used Intravenous anesthesia. Intraoperative and postoperative analgesia The analgesic was performed by the method of intravenous patient self-control and analgesia (PCIA), and the drug was sufentanil 100 ug, desmaxin 150mg, and ramosetron 0. 6mg, and diluted with normal saline. 100ml. Then, another anesthesiologist who did not know the grouping condition used the visual simulation scoring method (VAS) to evaluate the analgesic effect (including the VAS score at rest and cough) for 1h, 4h, 8h, 24h, 48h and 72h after the operation of the patient, and record the number of pressing times and adverse reactions of the PCIA. Postoperative complications, vital signs, sedation, nausea, and vomiting Score and The results were as follows: (1) VAS score at rest, 1 h, 4 h, and 8 h at rest, and there was a significant difference between group A and group B (P <0.05), and 24 hours after operation. The scores of analgesia in group A and group B were no significant difference (P0.05). (2) VAS score at the time of cough, the analgesic score of group A was significantly different from group B, and there was a significant difference between group B and group B (P <0.05). The analgesic scores of group A and group B were no significant difference after operation for 48h and 72h, and there was no statistics. The clinical significance (P 0.05). 2. The comparison of the additional analgesic drugs: the time interval between the two groups was compared with each other, and the number of pressing times for 1h, 4h, 8h and 24h after operation was significantly higher than that in group A (P0.05). The study significance (P0.05). The number of pressing times of 48h and 72h after operation was compared, and the group A and group B did not Significant difference (P0.05). 3. Comparison of postoperative cough and expectoration ability: A group of patients can better cooperate with cough and expectoration, and the respiratory tract The discharge of internal secretion, group A was better than that of group B. The results showed that the sedation score of group B was significantly lower in group A than in group A. The sedative effect of group B was poor in group B, and the rest of the time was the same. There was no significant difference in the sedation score (P0.05). The postoperative pain was less and the degree of satisfaction of group A was better than that of group B. Conclusion: After the intravenous infusion of lidocaine in the perioperative period of the thoracic surgery, the analgesic effect of the post-operative PCIA can be enhanced, the postoperative pain can be relieved, and the occurrence of postoperative complications is also reduced. and no severe lidocaine was observed.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R655;R614
本文編號：2421662
[Abstract]:Study Background: Pain is an unpleasant feeling or emotional experience caused by tissue damage or potential tissue damage. The post-operative pain is an acute pain that occurs immediately after the procedure, which is clinically common and requires a timely treatment. In various types of surgery, the pain in the thoracic surgery is particularly acute, which has also become the main cause of the patient's fear of the thoracic surgery. I. The primary cause of post-operative pain is the trauma of intercostal nerves, muscle ligaments, and the trauma of the incision and the stimulation of the body. and the like, and the pain after the operation can directly influence the amplitude of the breathing motion and the process of the cough and the sputum, so that the secretion of the secretion in the respiratory tract can be retained, and then the lung can not be caused, the pleural effusion, the chest infection and the like can be caused, and the severe person can even cause the respiratory failure and the death Therefore, the timely and effective and reasonable analgesia can not only improve the respiratory function of the patients after operation, reduce the occurrence of postoperative complications, but also promote the recovery of the patient from the operation of the operation as soon as possible. Complex. The method of self-controlled analgesia (PCIA), which is currently used in clinical use, is one of the most effective and effective methods for postoperative analgesia in patients with thoracic surgery, but a single analgesic method often does not achieve the desired analgesic effect. As a result, the use of two or more analgesic methods for compound analgesia is increasingly becoming the general trend Potential. Epidural pain is a well-recognized standard for postoperative analgesia, but its complications, contraindications and adverse reactions limit the clinical application of this method to a certain extent. In this paper, the analgesic effect of the postoperative patient-controlled analgesia (PCIA) in the patients with thoracic surgery was observed after the perioperative and intravenous injection of lidocaine in the patients with thoracic surgery. Objective: To observe the analgesic effect of the patient-controlled analgesia (PCIA) and the postoperative rehabilitation of the patients after the intravenous infusion of lidocaine in the perioperative period of the patients with thoracic surgery. Methods: 120 patients who underwent thoracic surgery under general anesthesia were randomly divided into two groups (n = 60). A group (group A of lidocaine) was used as lidocaine, fentanyl, sufentanil and zizine. in group B (control group), remifentanil, sufentanil, zizine, The postoperative self-controlled intravenous analgesia was performed in both groups of patients in the group A and B. PCIA). All patients have a unified surgical method and a method of anesthesia, both of which are all used Intravenous anesthesia. Intraoperative and postoperative analgesia The analgesic was performed by the method of intravenous patient self-control and analgesia (PCIA), and the drug was sufentanil 100 ug, desmaxin 150mg, and ramosetron 0. 6mg, and diluted with normal saline. 100ml. Then, another anesthesiologist who did not know the grouping condition used the visual simulation scoring method (VAS) to evaluate the analgesic effect (including the VAS score at rest and cough) for 1h, 4h, 8h, 24h, 48h and 72h after the operation of the patient, and record the number of pressing times and adverse reactions of the PCIA. Postoperative complications, vital signs, sedation, nausea, and vomiting Score and The results were as follows: (1) VAS score at rest, 1 h, 4 h, and 8 h at rest, and there was a significant difference between group A and group B (P <0.05), and 24 hours after operation. The scores of analgesia in group A and group B were no significant difference (P0.05). (2) VAS score at the time of cough, the analgesic score of group A was significantly different from group B, and there was a significant difference between group B and group B (P <0.05). The analgesic scores of group A and group B were no significant difference after operation for 48h and 72h, and there was no statistics. The clinical significance (P 0.05). 2. The comparison of the additional analgesic drugs: the time interval between the two groups was compared with each other, and the number of pressing times for 1h, 4h, 8h and 24h after operation was significantly higher than that in group A (P0.05). The study significance (P0.05). The number of pressing times of 48h and 72h after operation was compared, and the group A and group B did not Significant difference (P0.05). 3. Comparison of postoperative cough and expectoration ability: A group of patients can better cooperate with cough and expectoration, and the respiratory tract The discharge of internal secretion, group A was better than that of group B. The results showed that the sedation score of group B was significantly lower in group A than in group A. The sedative effect of group B was poor in group B, and the rest of the time was the same. There was no significant difference in the sedation score (P0.05). The postoperative pain was less and the degree of satisfaction of group A was better than that of group B. Conclusion: After the intravenous infusion of lidocaine in the perioperative period of the thoracic surgery, the analgesic effect of the post-operative PCIA can be enhanced, the postoperative pain can be relieved, and the occurrence of postoperative complications is also reduced. and no severe lidocaine was observed.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R655;R614
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