本文選題：帕瑞昔布鈉 + 鎮(zhèn)痛��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:觀察應(yīng)用帕瑞昔布鈉進行預(yù)防性鎮(zhèn)痛對行開腹膽囊切除術(shù)患者術(shù)后鎮(zhèn)痛效果的影響。方法:選取擇期行膽囊切除術(shù)患者60例,隨機分為兩組,即對照組(C組)和帕瑞昔布鈉組(P組),每組30例。每組患者均不用術(shù)前藥,入室后常規(guī)監(jiān)測心電圖(ECG),血壓(NIBP),脈搏血氧飽和度(SpO2)。全麻常規(guī)誘導(dǎo)后,可視喉鏡明視下進行氣管插管。術(shù)中麻醉維持采取全憑靜脈麻醉方式,靜脈持續(xù)泵入異丙酚和瑞芬太尼,維持術(shù)中血壓波動不超過基礎(chǔ)值的20%。術(shù)中補液均液體加溫,按晶:膠比2:1比例輸入,并視術(shù)中出血量調(diào)整輸液速度。手術(shù)開始切皮前20 min:C組靜脈注射0.9%生理氯化鈉2 ml,P組靜脈注射帕瑞昔布鈉40 mg。手術(shù)關(guān)腹前兩組患者均給予地佐辛0.08 mg/kg靜點,手術(shù)縫皮時停止泵注異丙酚和瑞芬太尼,靜脈三通連接術(shù)后鎮(zhèn)痛泵并開啟。術(shù)畢患者帶氣管導(dǎo)管,簡易呼吸囊輔助呼吸送入恢復(fù)室。記錄兩組患者的蘇醒時間、拔管時間、意識恢復(fù)時間、拔管時Riker評分(SAS)及寒顫、躁動發(fā)生率;記錄術(shù)后2 h、4 h、8 h、12 h、24 h的疼痛評分(VAS評分),術(shù)后鎮(zhèn)痛泵按壓次數(shù)及術(shù)后惡心嘔吐、頭暈、呼吸抑制的發(fā)生率。躁動評分采用Riker鎮(zhèn)靜及躁動評分(SAS),疼痛評分標(biāo)準(zhǔn)采用疼痛視覺模擬評分(VAS)。結(jié)果:兩組患者蘇醒時間、拔管時間、意識恢復(fù)時間無顯著差異。與C組比較,P組拔管時SAS評分顯著低于C組(P0.05)且拔管后躁動發(fā)生率P組明顯低于C組(P0.05);P組術(shù)后各時間點VAS評分均低于C組,且術(shù)后鎮(zhèn)痛泵按壓總次數(shù)顯著少于C組,兩組差異有統(tǒng)計學(xué)意義(P0.05)。與C組相比,P組術(shù)后惡心嘔吐的發(fā)生率明顯小于C組,結(jié)果有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:帕瑞昔布鈉預(yù)防性鎮(zhèn)痛可降低全麻患者蘇醒期躁動的發(fā)生率,而且可以減少術(shù)后鎮(zhèn)痛藥物的用量,可以安全、有效的應(yīng)用于臨床。
[Abstract]:Aim: to observe the effect of prophylactic analgesia with paroxib sodium on postoperative analgesia in patients undergoing open cholecystectomy.Methods: sixty patients undergoing elective cholecystectomy were randomly divided into two groups: control group (C group) and paroxib sodium group (30 cases in each group).The patients in each group did not need preoperative medication. The ECG, blood pressure, pulse oxygen saturation and SPO _ 2 were monitored.Tracheal intubation was performed under visual laryngoscope after general anesthesia induction.Intraoperative anesthesia was maintained by total intravenous anesthesia with intravenous infusion of propofol and remifentanil.During the operation, the fluid was heated and the transfusion velocity was adjusted according to the volume of blood loss during the operation according to the ratio of crystal to glue at 2:1.20 min:C before the operation, 0.9% physiological sodium chloride was injected intravenously into group P and 40 mg of paroxib sodium was injected intravenously.The patients in the two groups were given dizosin 0.08 mg/kg statically before operation. Propofol and remifentanil were stopped during suture, and the postoperative analgesic pump was connected with the three-way venous connection and turned on.After operation, the patient with trachea catheter, simple respiratory sac assisted breathing into the recovery room.The recovery time, extubation time, consciousness recovery time, Riker score during extubation, chills and restlessness were recorded in both groups, and the pain scores of 2 h, 4 h, 8 h, 12 h and 24 h after operation were recorded, the number of postoperative analgesic pump compressions and postoperative nausea and vomiting were recorded.The incidence of dizziness and respiratory depression.Riker sedation and restlessness scores were used in restlessness scale and pain score was used as visual analogue score.Results: there was no significant difference in recovery time, extubation time and consciousness recovery time between the two groups.Compared with group C, the SAS score of extubation in group P was significantly lower than that in group C (P 0.05), and the incidence of restlessness after extubation in group P was significantly lower than that in group C (P 0.05). The VAS score of group P was lower than that of group C at each time point after extubation, and the total number of postoperative analgesic pump compression was significantly less than that of group C.The difference between the two groups was statistically significant (P 0.05).Compared with group C, the incidence of postoperative nausea and vomiting in group P was significantly lower than that in group C (P 0.05).Conclusion: the prophylactic analgesia with paroxib sodium can reduce the incidence of restlessness in patients with general anesthesia and reduce the dosage of postoperative analgesic drugs. It can be used safely and effectively in clinical practice.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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