本文關(guān)鍵詞： 病人自控鎮(zhèn)痛 背景輸注速度 剖宮產(chǎn)術(shù)后 鎮(zhèn)痛效果 不良反應(yīng)　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察并評(píng)估無背景輸注的鎮(zhèn)痛模式應(yīng)用于剖宮產(chǎn)術(shù)后產(chǎn)婦的鎮(zhèn)痛效果、用藥量及副作用的情況。方法:選擇健康無合并癥的產(chǎn)婦30名(ASAⅠ~Ⅱ),擇期剖宮產(chǎn)手術(shù)在腰硬聯(lián)合麻醉下施行。將30名產(chǎn)婦隨機(jī)分為兩組,對(duì)照組采用傳統(tǒng)給藥模式:單次給藥劑量0.5ml,鎖定時(shí)間10分鐘,背景輸注速度為2ml/h。試驗(yàn)組采用完全自控?zé)o背景輸注模式:單次給藥劑量1ml,鎖定時(shí)間10分鐘,無背景輸注速度。鎮(zhèn)痛藥均為噴他佐辛150mg+芬太尼0.5mg配置在100ml生理鹽水中。術(shù)中記錄出血量及手術(shù)時(shí)間。同時(shí)兩組均在手術(shù)結(jié)束前15分鐘靜脈給予30mg噴他佐辛和5mg托烷司瓊。術(shù)后拔出硬膜外導(dǎo)管,連接PCIA泵,將病人送回病房。記錄兩組病人術(shù)后4h、8h、12h、24h疼痛視覺模擬評(píng)分(VAS評(píng)分)、鎮(zhèn)靜程度評(píng)分(Ramsay評(píng)分)、用藥量,記錄心動(dòng)過緩(HR60次/分或比輸注前值低20%以下)、低血壓(收縮壓90 mm Hg或比基礎(chǔ)值低20%以下,或舒張壓60 mm Hg)、呼吸抑制(呼吸頻率8次/分或比基線下降了20%以上)、惡心嘔吐、尿潴留(膀胱內(nèi)充滿尿液有尿意但不能排出)等不良反應(yīng)的發(fā)生情況。結(jié)果:與對(duì)照組相比,試驗(yàn)組在四個(gè)時(shí)間點(diǎn)的VAS評(píng)分及Ramsay評(píng)分均無顯著性差異。術(shù)后4h、8h、24h試驗(yàn)組的用藥總量與對(duì)照組相比顯著減少(P0.05)差異有統(tǒng)計(jì)學(xué)意義,而術(shù)后12h兩組用藥總量無顯著性差異。在術(shù)后0-4h試驗(yàn)組用藥量(3.47±1.60ml)與對(duì)照組(8.20±0.41ml)相比顯著性減少差異有統(tǒng)計(jì)學(xué)意義(P0.05)。而術(shù)后4-8h試驗(yàn)組與對(duì)照組用藥量分別為7.87±2.70ml和8.47±0.55ml,比較無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后8-12h試驗(yàn)組用藥量(11.47±3.18ml)顯著高于對(duì)照組用藥量(8.30±0.41ml),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后12-24h試驗(yàn)組(21.73±7.41ml)與對(duì)照組(24.40±0.71ml)用藥量無統(tǒng)計(jì)學(xué)差異(P0.05)。與對(duì)照組(33.3%)相比,試驗(yàn)組(26.7%)惡心的發(fā)生率顯著性降低。兩組均未出現(xiàn)心動(dòng)過緩,血壓下降,呼吸抑制、尿潴留及嘔吐等不良反應(yīng)。結(jié)論:無背景輸注的完全自控鎮(zhèn)痛模式在剖宮產(chǎn)術(shù)后產(chǎn)婦中的應(yīng)用,既保證了鎮(zhèn)痛鎮(zhèn)靜效果,又降低了用藥量及不良反應(yīng)的發(fā)生率。
[Abstract]:Objective: to observe and evaluate the analgesic effect of the analgesic mode without background infusion in the parturient after cesarean section. Methods: 30 healthy women without complications were selected to perform elective cesarean section under combined spinal-epidural anesthesia. 30 parturients were randomly divided into two groups. The control group was treated with traditional administration mode: single dose of 0.5 ml, locking time of 10 minutes. The speed of background infusion was 2 ml / h. The experimental group was given a single dose of 1 ml, and the locking time was 10 minutes. No background infusion speed. Analgesics are sprayed with tarzosin 150 mg. 0.5 mg fentanyl was administered in 100ml saline. Blood loss and operation time were recorded during operation. Both groups were given 30 mg pentazol and 5 mg tropisetron 15 minutes before the end of operation. After operation, the epidural catheter was removed. The patients were connected with PCIA pump and sent back to the ward. The visual analogue score of pain and the score of sedation degree and the score of Ramsay were recorded in the two groups at 4 h, 8 h, 12 h and 24 h after operation. The HR60 times / min of bradycardia or less than 20% times lower than the value before infusion, hypotension (systolic pressure 90mm Hg or lower than 20% below the base value) were recorded. Or diastolic pressure 60mm HgG, respiratory inhibition (respiratory frequency 8 times / min or lower than baseline by more than 20%), nausea and vomiting. Adverse effects of urinary retention (bladder filled with urine but not excreted). Results: compared with control group. There was no significant difference in VAS score and Ramsay score at four time points in the trial group. Compared with the control group, the total amount of drug used in the 24 h trial group decreased significantly (P 0.05). However, there was no significant difference between the two groups at 12 hours after operation, and the dosage in the trial group was 3.47 鹵1.60 ml in 0-4 h after operation, and 8.20 鹵0.41 ml in the control group. There was significant difference between the two groups (P 0.05), but the dosage of the test group and the control group were 7.87 鹵2.70 ml and 8.47 鹵0.55 ml respectively at 4-8 hours after operation. There was no significant difference between the two groups (P 0.05). The dosage in the test group was 11.47 鹵3.18 ml in 8-12 hours after operation, which was significantly higher than that in the control group (8.30 鹵0.41 ml). There was no significant difference in dosage between the trial group (21.73 鹵7.41 ml) and the control group (24.40 鹵0.71 ml) after 12-24 h operation (P 0.05). Compared with control group (P 0.05). The incidence of nausea in the trial group was significantly lower than that in the control group. There was no bradycardia, decreased blood pressure and respiratory depression in both groups. Conclusion: the application of complete self-controlled analgesia without background in postpartum cesarean section can not only ensure the analgesic effect, but also reduce the amount of drugs used and the incidence of adverse reactions.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 劉興進(jìn);譚玉元;楊捷;;噴他佐辛靜脈自控鎮(zhèn)痛對(duì)剖宮產(chǎn)術(shù)后產(chǎn)婦泌乳素水平的影響[J];醫(yī)學(xué)綜述;2016年03期

2 陳紅芽;徐銘軍;;超聲引導(dǎo)下腹橫肌平面阻滯在剖宮產(chǎn)術(shù)后鎮(zhèn)痛中的應(yīng)用[J];北京醫(yī)學(xué);2015年08期

3 張旱愉;崔睿;王寶君;張韻;劉艷嫦;劉湘梅;;不同鎮(zhèn)痛方式對(duì)剖宮產(chǎn)術(shù)后鎮(zhèn)痛效果及并發(fā)癥的影響[J];齊魯護(hù)理雜志;2013年06期

4 徐建國;;成人術(shù)后疼痛治療進(jìn)展[J];臨床麻醉學(xué)雜志;2011年03期

5 洪溪;黃宇光;羅愛倫;;術(shù)后鎮(zhèn)痛的規(guī)范化管理[J];中華麻醉學(xué)雜志;2005年10期

6 羅友軍;剖宮產(chǎn)術(shù)后疼痛調(diào)查[J];張家口醫(yī)學(xué)院學(xué)報(bào);2001年02期

，

本文編號(hào)：1457273