本文選題：右美托咪定　切入點：氟比洛芬酯　出處：《延安大學(xué)》2017年碩士論文

【摘要】：目的:良性前列腺增生(BPH)是泌尿外科臨床上的常見病、多發(fā)病之一,多發(fā)生于50歲以上的老年男性。目前經(jīng)尿道前列腺電切術(shù)(Transure—thral Resection of Prostate,TURP)因其對患者打擊小,痛苦較少,恢復(fù)迅速以及縮短總住院時間等優(yōu)點,已經(jīng)逐漸取代傳統(tǒng)的開放手術(shù),成為治療BPH的金標(biāo)準(zhǔn)。老年人由于疾病、社會環(huán)境改變等因素在圍術(shù)期易產(chǎn)生緊張、焦慮和抑郁等消極情緒,降低痛閾,增加術(shù)后對疼痛的敏感性,認(rèn)知改變,影響預(yù)后,增加術(shù)后并發(fā)癥從而增加圍術(shù)期患者自身的痛苦,對手術(shù)及圍術(shù)期管理造成困難。這就要求一個良好的術(shù)后鎮(zhèn)痛管理。本研究比較右美托咪啶(Dexmedetomidine,Dex)與氟比洛芬酯用于術(shù)后鎮(zhèn)痛的安全性、不良反應(yīng)和鎮(zhèn)痛滿意度,評價Dex用于老年人TURP手術(shù)術(shù)后鎮(zhèn)痛的質(zhì)量及效果。方法:選取延安大學(xué)附屬醫(yī)院2016年6月至2017年1月60例接受TURP手術(shù)的患者,ASA I~II級,隨機分為Dex+氟比洛芬酯組(A組)和單用氟比洛芬酯(B組),每組30例。兩組均使用0.75%左布比卡因行腰硬聯(lián)合麻醉,麻醉平面控制在T10以下。手術(shù)結(jié)束后A組給予Dex0.1ug/kg/h+氟比洛芬酯300mg+托烷司瓊10mg,配置100ml;B組給予氟比洛芬酯300mg+托烷司瓊10mg,配置100ml,設(shè)置術(shù)后鎮(zhèn)痛泵以2ml/h速率,按壓2ml/次,鎖定時間為15min。主要觀察指標(biāo):一般情況(兩組患者身高、體重、年齡),術(shù)前(T0)、術(shù)后2小時(T1)、術(shù)后4小時(T2)、術(shù)后8小時(T3)、術(shù)后12小時(T4)、術(shù)后24小時(T5)、術(shù)后48小時(T6)7個時間點兩組患者視覺模擬量表(VAS)評分,Ramsay鎮(zhèn)靜評分,患者第一次按壓鎮(zhèn)痛泵的時間、48小時按壓鎮(zhèn)痛泵次數(shù)以及術(shù)后需要額外處理的鎮(zhèn)痛次數(shù)。記錄術(shù)后并發(fā)癥,皮膚瘙癢、惡心嘔吐、術(shù)后寒顫、呼吸抑制發(fā)生率、患者滿意度和術(shù)后護(hù)理滿意度。次要指標(biāo)為各個時間點患者的心率(HR)、平均動脈壓(MAP)、收縮壓(SBP)、舒張壓(DBP)、脈搏氧飽和度(Sp02)及手術(shù)時間。結(jié)果:1.兩組患者年齡、身高、體重和ASA分級、手術(shù)時間上差異均無統(tǒng)計學(xué)意義(P0.05);2.術(shù)后鎮(zhèn)痛方面A組的VAS評分低于B組,患者第一次按壓鎮(zhèn)痛泵的時間明顯延長(P=0.009);3.兩組患者Ramsay評分差異有統(tǒng)計學(xué)意義(P0.05),A組高于B組;4.兩組患者在術(shù)后惡心嘔吐、術(shù)后寒戰(zhàn)發(fā)生進(jìn)行統(tǒng)計學(xué)比較,差異有統(tǒng)計學(xué)意義,A組低于B組;5.兩組患者術(shù)后血流動力學(xué)組內(nèi)比較,A組血流動力學(xué)較B組穩(wěn)定;6.兩組患者在術(shù)后護(hù)理的滿意度評分A組高于B組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:Dex可有效的用于經(jīng)尿道前列腺電切手術(shù)術(shù)后鎮(zhèn)痛,鎮(zhèn)靜效果和安全性較好,患者血流動力學(xué)更加穩(wěn)定,并發(fā)癥的發(fā)生率有所降低,術(shù)后護(hù)理滿意度高。
[Abstract]:Objective: benign prostatic hyperplasia (BPH) is a common disease in urology.At present, transure-thral Resection of prostate transurethral transurethral resection (TURP) has gradually replaced the traditional open operation as the gold standard for the treatment of BPH because of its advantages of less attack, less pain, rapid recovery and shorter total hospital stay.Because of diseases, social environment changes and other factors, elderly people are prone to produce negative emotions such as tension, anxiety and depression during perioperative period, reduce pain threshold, increase postoperative sensitivity to pain, change cognition, and affect prognosis.Increasing postoperative complications and increasing the pain of perioperative patients make it difficult to manage the operation and perioperative period.This requires a good postoperative analgesia management.The purpose of this study was to compare the safety, adverse reactions and analgesic satisfaction of dexmememedetomidineine and flurbiprofen in postoperative analgesia, and to evaluate the quality and effect of Dex for postoperative analgesia in elderly patients with TURP.Methods: from June 2016 to January 2017, 60 patients undergoing TURP operation in Yan'an University affiliated Hospital were randomly divided into Dex flurbiprofen group (A group) and flurbiprofen group B (30 cases in each group).Both groups were treated with 0.75% levobupivacaine under combined spinal-epidural anesthesia.After operation, group A was given Dex0.1ug/kg/h flurbiprofen ester, 300mg tropisetron 10 mg, group B was given flurbiprofen ester, 300mg tropisetron 10 mg, and postoperative analgesia pump was set up at 2ml/h rate, pressing 2ml/ times, locking time was 15 minutes.Main outcome measures: general condition (height, weight of patients in two groups),The time of the first analgesia pump was 48 hours.Postoperative complications, skin itching, nausea and vomiting, postoperative chills, respiratory depression, patient satisfaction and postoperative nursing satisfaction were recorded.The secondary indexes were heart rate HRV, mean arterial pressure MAPP, SBP, DBP, pulse oxygen saturation (SP02) and operation time.The result is 1: 1.There was no significant difference in age, height, weight, ASA grade and operation time between the two groups.The difference of Ramsay score between the two groups was statistically significant (P 0.05) and higher than that in group B (4. 5%).Two groups of patients in postoperative nausea and vomiting, postoperative shivering were compared statistically, the difference was statistically significant lower in group A than in group B.Comparison of hemodynamics in two groups after operation, hemodynamics in group A was more stable than that in group B (6. 5%).The satisfaction score of postoperative nursing in group A was higher than that in group B, and the difference was statistically significant (P 0.05).ConclusionTwain Dex can be effectively used for postoperative analgesia after transurethral resection of prostate. The sedation effect and safety are better, hemodynamics is more stable, the incidence of complications is lower, and the postoperative nursing satisfaction is high.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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