本文選題：鎮(zhèn)痛 + 吸煙　； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：背景:目前國內(nèi)對于吸煙患者術(shù)前大多會常規(guī)戒煙,但對于尼古丁依賴患者與其術(shù)后疼痛方面的研究仍較少,與此同時我國吸煙的患者并不在少數(shù)。長期的尼古丁暴露可以改變疼痛通路的結(jié)構(gòu)與功能,還可能發(fā)生尼古丁耐受,導致尼古丁依賴患者對阿片類藥物產(chǎn)生耐受,術(shù)后阿片類藥物用量也相應(yīng)增加。探究如何為尼古丁依賴患者提供更完善的術(shù)后鎮(zhèn)痛方案,對于降低術(shù)后疼痛程度,減少阿片類藥物用量,降低呼吸道并發(fā)癥的發(fā)生率,改善肺功能,提高舒適度,促進術(shù)后恢復有著重要的意義。因此本文旨在探討不同術(shù)后鎮(zhèn)痛方式對行甲狀腺癌根治術(shù)吸煙患者的術(shù)后疼痛程度及術(shù)后阿片類藥物用量的影響。方法:選擇2016年06月至2016年11月我院收治的80例甲狀腺癌患者為研究對象,所有患者均經(jīng)頸部彩超和CT檢查,ASA分級均為I~II級,年齡在40~70歲之間的吸煙男性患者,實驗室血生化檢驗正常,甲狀腺功能無明顯異常。根據(jù)患者FTND評分將所有患者分為2組:低尼古丁依賴組(L組)和高尼古丁依賴組(H組);再將2組患者組內(nèi)隨機分為頸淺叢神經(jīng)阻滯組(C組)和PCIA組(I組)行不同方式的術(shù)后鎮(zhèn)痛,即共分為LC、LI、HC、HI 4組,其中HI、LI組每組各22例,HC、LC每組各18例。C組患者在麻醉誘導前行超聲引導下雙側(cè)頸淺叢神經(jīng)阻滯,I組患者手術(shù)結(jié)束時開始使用PCIA鎮(zhèn)痛泵。記錄術(shù)中的舒芬太尼及瑞芬太尼的用量;記錄拔管后1分鐘(T1)、出PACU前(T2)、手術(shù)后24小時(T3)及手術(shù)后48小時(T4)患者靜息時及咳嗽時疼痛VAS評分、Ramsay鎮(zhèn)靜評分;記錄T1、T2、T3、T4時舒芬太尼用量及其他鎮(zhèn)痛藥用量;記錄患者PONV、頸叢神經(jīng)阻滯后并發(fā)癥、術(shù)后肺部并發(fā)癥、LOS等情況。術(shù)后其他鎮(zhèn)痛藥物用量換算為等量的舒芬太尼用量,并計入舒芬太尼總用量。結(jié)果:HI、HC組在四個時刻疼痛VAS評分均明顯較LI、LC組高,但僅在T1、T2咳嗽時及T3時具有統(tǒng)計學意義(P㧐0.05);HI組與HC組及LI組與LC組分別相比較各個時刻的VAS評分并沒有明顯統(tǒng)計學差異(P㧐0.05)。四組在術(shù)中舒芬太尼用量的差異沒有統(tǒng)計學意義(P㧐0.05)。HI組、LI組手術(shù)中瑞芬太尼用量分別明顯高于HC組、LC組,并具有統(tǒng)計學意義(P㩳0.05);HI組與LI組及HC組與LC組手術(shù)中瑞芬太尼用量分別比較并沒有明顯統(tǒng)計學差異(P㩳0.05)。HI組在四個時刻舒芬太尼用量均明顯較LI組高,但僅在T2、T3、T4時具有統(tǒng)計學意義(P㩳0.05);HC組在T2、T3、T4時舒芬太尼用量均較LC組高,但兩組在四個時刻均沒有統(tǒng)計學差異(P㧐0.05);HI組、LI組在四個時刻舒芬太尼用量分別明顯高于HC組、LC組,并具有統(tǒng)計學意義(P㩳0.05)。HI組、LI組PONV發(fā)生率分別高于HC組、LC組,但并沒有明顯統(tǒng)計學差異(P㧐0.05)。四組在不同時刻的Ramsay鎮(zhèn)靜評分差異無統(tǒng)計學意義(P㧐0.05)。四組在LOS上也沒有明顯差異(P㧐0.05)。C組均未發(fā)生頸叢神經(jīng)阻滯后并發(fā)癥。四組均沒有肺部并發(fā)癥發(fā)生。結(jié)論:行甲狀腺癌根治術(shù)的吸煙患者中尼古丁依賴程度越高,其術(shù)后疼痛程度越高,術(shù)后鎮(zhèn)痛藥物用量越多;全身麻醉聯(lián)合頸淺叢神經(jīng)阻滯可以有效減少吸煙患者術(shù)后鎮(zhèn)痛藥物用量。
[Abstract]:Background: at present the most common smoking patients quit smoking, but for nicotine dependence patients and postoperative pain research is still less, at the same time our country smoking patients is not in the minority. The long-term nicotine exposure can change the structure and function of pain pathways, may also occur in patients with nicotine tolerance, nicotine dependence and tolerance for opioids, postoperative opioid consumption also increased. How to explore analgesic regimen of nicotine dependent patients to provide better postoperative pain to reduce postoperative, reduce the dosage of opioids, reduce respiratory complications, improve lung function, improve comfort, promote the postoperative recovery has important significance. This paper aims to explore the different analgesia methods for resection of thyroid cancer in smoking patients postoperative pain and postoperative. Effect of opioid dosage. Methods: 80 cases of patients with thyroid cancer in 2016 06 months to November 2016 in our hospital as the research object, all patients were treated by cervical ultrasonography and CT examination, ASA were grade I~II, age between 40~70 years old male smoking patients, normal blood biochemical laboratory, thyroid function according to the FTND score in patients with abnormal. All patients were divided into 2 groups: low nicotine dependence group (L group) and high nicotine dependence group (H group); the 2 group patients were randomly divided into superficial cervical plexus block group (C group) and PCIA group (I group) for different ways postoperative analgesia, which is divided into LC, LI, HC, HI 4 group, HI LI group, 22 cases in each group, HC, LC each of the 18 cases of.C patients during general anesthesia induction on ultrasound-guided bilateral superficial cervical plexus block, analgesia pump end started using PCIA group I. Intraoperative sufentanil and Rui 鑺お灝肩殑鐢ㄩ噺;璁板綍鎷旂鍚，

本文編號：1746172