本文選題：加巴噴丁　切入點：圍術(shù)期鎮(zhèn)痛　出處：《西南醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討圍術(shù)期應(yīng)用加巴噴丁膠囊能否減輕開胸手術(shù)后急性疼痛的嚴重程度、術(shù)后24h內(nèi)鎮(zhèn)痛藥的用量,以及術(shù)后2個月慢性疼痛的發(fā)生率,神經(jīng)病理性疼痛的發(fā)生率,從而改善患者的生活質(zhì)量。方法:選擇符合納入和排除標準的患者80例,隨機分為四組,實驗組G1組、實驗組G2組、實驗組G3和對照組C組,每組20例。G1組于術(shù)前2h口服加巴噴丁膠囊300mg,術(shù)后服用安慰劑;G2組于術(shù)前2h口服加巴噴丁膠囊300mg,手術(shù)后6h服用加巴噴丁100mg,術(shù)后第一天開始服用加巴噴丁100mg tid至術(shù)后7天;G3組于術(shù)前2h口服加巴噴丁膠囊300mg,手術(shù)后6h服用加巴噴丁300mg,術(shù)后第一天開始服用加巴噴丁300mg至術(shù)后7天;C組為對照組,術(shù)前術(shù)后均給予安慰劑。四組患者切皮前30分鐘均靜脈滴注帕瑞昔布鈉40mg,術(shù)后均常規(guī)應(yīng)用靜脈鎮(zhèn)痛泵PCIA進行術(shù)后自控鎮(zhèn)痛(配方為:舒芬太尼100ug+托烷司瓊5mg,用生理鹽水配制成120ml)。觀察術(shù)后4h、8h、12h、24h、48h、72h、96h和120h病人的疼痛視覺模擬評分(VAS評分);術(shù)后24h靜脈鎮(zhèn)痛藥使用量、主動按壓bolus次數(shù)及術(shù)后嗜睡、惡心、嘔吐、呼吸困難、眩暈、視物模糊及瘙癢等不良反應(yīng);電話隨訪術(shù)后2月患者的慢性疼痛發(fā)生率及術(shù)后神經(jīng)病理性疼痛的發(fā)生率,并對術(shù)后2月患者的焦慮和睡眠質(zhì)量進行全面評估。結(jié)果:1.四組患者的年齡、性別構(gòu)成、身高、體重、手術(shù)時間均無統(tǒng)計學(xué)差異(P0.05)。2.四組患者術(shù)后VAS評分8h以內(nèi)均無統(tǒng)計學(xué)差異(P0.05),術(shù)后8h及以上G1組與C組相比無統(tǒng)計學(xué)意義(P0.05);G2、G3組與C組比較有統(tǒng)計學(xué)差異,G2、G3組VAS評分小于C組;G2、G3組與G1組相比,G2、G3組術(shù)后8h以上VAS評分小于G1組(P0.05);G3組與G2組相比,5天以內(nèi)的各組VAS評分均無統(tǒng)計學(xué)差異(PO.O5)。3.術(shù)后24小時內(nèi)舒芬太尼用量和bolus次數(shù)比較,G1組、G2組、G3組與C組比較均有統(tǒng)計學(xué)差異,兩組數(shù)據(jù)G1、G2、G3組均小于C組;G2、G3組與G1組比較也有統(tǒng)計學(xué)意義,G2、G3組均小于G1組;在G2和G3兩組之間比較,無明顯統(tǒng)計學(xué)意義(P0.05).4.術(shù)后不良反應(yīng)發(fā)生率比較,惡心的發(fā)生率G1、G2、G3組均低于C組,差異有統(tǒng)計學(xué)意義;嗜睡的發(fā)生率,C組低于G2、G3組,G1組低于G2組,G2組低于G3組,結(jié)果均有統(tǒng)計學(xué)意義(P0.05)。5.術(shù)后2個月慢性疼痛發(fā)生率比較,G1組與C組比較未見明顯統(tǒng)計學(xué)差異;G2、G3組與C組比較,發(fā)生率低于C組,有明顯統(tǒng)計學(xué)意義(P0.05);G3組與G1組比較,也有統(tǒng)計學(xué)差異,慢性疼痛發(fā)生率低于G1組;G2、G3組之間比較無統(tǒng)計學(xué)差異。神經(jīng)病理性疼痛比較,G1組與C組比較亦無統(tǒng)計學(xué)意義;G2、G3組與C組比較有統(tǒng)計學(xué)意義,發(fā)生率小于C組;其余無統(tǒng)計學(xué)差異。6.術(shù)后2個月焦慮和睡眠質(zhì)量指數(shù)比較,G2組、G3組與C組比較有統(tǒng)計學(xué)意義,評分小于C組;G2、G3組與G1組比較有統(tǒng)計學(xué)差異,評分小于G1組;其余比較無明顯統(tǒng)計學(xué)意義。結(jié)論:1.術(shù)前300mg加巴噴丁對術(shù)后的急性疼痛評分和術(shù)后2個月的慢性疼痛發(fā)生率以及神經(jīng)病理性疼痛發(fā)生率沒有顯著影響,但可以減少術(shù)后患者對阿片類藥物的需要量。2.術(shù)前加術(shù)后持續(xù)應(yīng)用加巴噴丁的方式可減少術(shù)后急性疼痛的評分和術(shù)后2個月慢性疼痛的發(fā)生率,且不良反應(yīng)發(fā)生率較少。3.圍手術(shù)期應(yīng)用加巴噴丁可減少術(shù)后2個月神經(jīng)病理性疼痛的發(fā)生。
[Abstract]:Objective: To investigate the perioperative application of gabapentin to severity of acute pain after thoracic surgery, the amount of 24h in the postoperative analgesic, and 2 months after surgery, the incidence of chronic pain, the incidence of neuropathic pain, so as to improve the quality of life of patients. Methods: 80 cases with inclusion and exclusion the patients were randomly divided into four groups, group G1, group G2, group G3 and control group C, each group of 20 cases in.G1 group, 2h preoperative oral gabapentin capsules 300mg, placebo after operation; group G2 in preoperative 2H plus oral gabapentin 300mg after surgery 6h gabapentin 100mg, after the first day to the 7 day 100mg TID to gabapentin after operation; group G3 in preoperative 2H oral gabapentin 300mg, gabapentin 300mg 6h after surgery, postoperative first day to the 7 day after surgery to gabapentin 300mg; C group of Control group before and after surgery were given placebo. Four groups of patients before skin incision 30 minutes intravenous injection of parecoxib sodium 40mg, postoperative routine use of intravenous analgesia for postoperative patient-controlled analgesia (PCIA formula: 100ug+ sufentanil and tropisetron 5mg with normal saline into 120ml) observation. After 4h, 8h, 12h, 24h, 48h, 72h, 96h and visual analogue score (VAS score) in 120h patients; 24h intravenous analgesic usage after operation, active compression bolus times and postoperative nausea, vomiting, lethargy, dyspnea, dizziness, blurred vision and pruritus and other adverse reactions telephone follow-up; postoperative chronic pain patients in February and the incidence of postoperative neuropathic pain and the incidence of anxiety and sleep quality in February to conduct a comprehensive assessment of patients after operation. Results: 1. of the four groups in age, gender, height, weight, there was no difference in operation time (P0.05).2. four group patients 鏈悗VAS璇勫垎8h浠ュ唴鍧囨棤緇熻瀛﹀樊寮，

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