本文關(guān)鍵詞： 婦科腹腔鏡手術(shù) 術(shù)后鎮(zhèn)痛 帕瑞昔布鈉 羅哌卡因　出處：《延邊大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析帕瑞昔布鈉和羅哌卡因局部麻醉對(duì)婦科腹腔鏡術(shù)后鎮(zhèn)痛效果。方法選擇本院2015年12月至2016年6月間行婦科腹腔鏡手術(shù)患者120例,隨機(jī)分為帕瑞昔布鈉組(P組,n=30),羅哌卡因組(R組,n=30),帕瑞昔布鈉和羅哌卡因聯(lián)合組(PR組,n=30)和對(duì)照組(C組n=30)。P組患者均在手術(shù)結(jié)束前半小時(shí)靜脈注射帕瑞昔布鈉40mg,R組分別在二氧化碳?xì)飧菇⒑蠛托g(shù)畢前腹腔內(nèi)噴灑以及手術(shù)結(jié)束縫皮前創(chuàng)緣皮下注射0.66%的羅哌卡因10ml,PR組同時(shí)接受P組和R組的干預(yù)措施,C組在相同時(shí)間不接受任何臨床干預(yù)。所有患者都給予術(shù)后自控鎮(zhèn)痛泵(PCA泵)并記錄比較術(shù)畢lh、3h、6h、12h和1d各時(shí)間點(diǎn)的視覺模擬疼痛評(píng)分(VAS評(píng)分)、Ramsay鎮(zhèn)靜評(píng)分(RS評(píng)分)、舒適度評(píng)分(BCS評(píng)分)、PCA泵按壓次數(shù)、芬太尼總使用量及相關(guān)不良反應(yīng)的發(fā)生率。結(jié)果術(shù)后各時(shí)間點(diǎn)記錄的各項(xiàng)數(shù)據(jù)顯示,P組、R組及PR組的VAS評(píng)分均明顯低于C組,并且在術(shù)后6h時(shí),PR組的VAS評(píng)分低于R組;P組、R組及PR組患者在術(shù)后lh時(shí)擁有比C組更適宜的鎮(zhèn)靜評(píng)分;術(shù)后lh和6h時(shí),P組、R組、PR組的BCS評(píng)分均高于C組,并且術(shù)后12h和24h時(shí),P組的BCS評(píng)分高于PR組;術(shù)后各時(shí)間點(diǎn)的P組、R組、PR組的PCA泵按壓次數(shù)均明顯低于C組,并且在術(shù)后lh,3h,6h,12h時(shí),PR組的PCA泵按壓次數(shù)均少于P組,術(shù)后6h時(shí),PR組的PCA泵按壓次數(shù)少于R組;術(shù)后各時(shí)間點(diǎn)的P組、R組、PR組芬太尼總用量均明顯少于C組,并且術(shù)后lh時(shí)的PR組芬太尼總用量少于P組,術(shù)后3h時(shí)PR組的芬太尼總用量少于P組和R組;術(shù)后各時(shí)間點(diǎn)的P組、R組、PR組出現(xiàn)惡心、嘔吐等不良反應(yīng)的次數(shù)均明顯少于C組,各項(xiàng)數(shù)據(jù)檢驗(yàn)結(jié)果均有統(tǒng)計(jì)學(xué)意義(P0.001)。結(jié)論術(shù)畢前半小時(shí)靜脈注射帕瑞昔布鈉,氣腹建立時(shí)和術(shù)畢時(shí)腹腔內(nèi)噴灑合并手術(shù)切口注射羅哌卡因均能夠在婦科腹腔鏡手術(shù)術(shù)后疼鎮(zhèn)痛過程中明顯減少術(shù)后芬太尼的總使用量和不良反應(yīng),并同時(shí)有效緩解患者的術(shù)后疼痛,為患者提供各完善的鎮(zhèn)痛方案,效果且安全可靠,并且為二者在臨床中的廣泛應(yīng)用,提供參考依據(jù)。
[Abstract]:Objective to analyze the analgesic effect of paroxibum sodium and ropivacaine on postoperative analgesia after gynecological laparoscopy. Methods 120 patients undergoing gynecologic laparoscopic surgery from December 2015 to June 2016 were selected. They were randomly divided into two groups: paroxib sodium group (n = 30), ropivacaine group (n = 30), ropivacaine group (n = 30) and control group C (n = 30) and control group C (n = 30). All patients in group C were injected with paroxib sodium (40 mg / L) half an hour before the end of operation. After the establishment of carbon dioxide pneumoperitoneum and before the end of operation intraperitoneal spraying and subcutaneous injection of 0.66% ropivacaine 10 ml bun PR group at the same time to receive P and R intervention group C do not receive any clinical at the same time. Intervention. All patients were given PCApump (PCA pump) and recorded visual analogue pain score (VAS) and Ramsay sedation score (Ramsay sedation score), comfort score (BCS score) and PCA pump pressing times at different time points (1hh ~ 3h ~ 6h ~ 12h and 1d) after operation. Results the data recorded at each time point after operation showed that the VAS scores of group R and group PR were significantly lower than those of group C. At 6 h after operation, the VAS score of PR group was lower than that of R group P group R group and PR group group, and the BCS score of P group was higher than that of C group at 1 h and 6 h after operation, and the BCS score of P group was higher than that of group C at 1 h and 6 h after operation, and the BCS score of P group was higher than that of group C at 1 h and 6 h after operation. The BCS score of P group was higher than that of PR group at 12 h and 24 h after operation, the times of PCA pump compression in P group and R group were significantly lower than those in group C at 12 h and 24 h after operation, and the times of PCA pump compression in group P were lower than those in group P at 1 h, 3 h, 6 h and 12 h after operation. At 6 h after operation, the times of PCA pump pressing in PR group were less than those in R group, the total dosage of fentanyl in P group was significantly lower than that in group C at each time point, and the total dosage of fentanyl in PR group was less than that in group P at 1 h after operation. At 3 h after operation, the total dosage of fentanyl in PR group was less than that in P group and R group, and the number of adverse reactions such as nausea and vomiting in P group R group was significantly less than that in C group. The results of each data test were statistically significant (P 0.001). Conclusion the sodium paroxib was injected intravenously half an hour before the end of operation. Both intraperitoneal spraying and incision injection of ropivacaine at the time of establishment of pneumoperitoneum and at the end of operation could significantly reduce the total usage and adverse reactions of fentanyl during postoperative pain and analgesia in gynecological laparoscopic surgery. At the same time, it can effectively relieve the postoperative pain and provide the patients with complete analgesic schemes, the effect is safe and reliable, and they can be widely used in clinical, and provide a reference for the patients.
【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

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