本文選題：鎮(zhèn)痛 + 鎮(zhèn)靜　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探索程序化鎮(zhèn)痛鎮(zhèn)靜治療對(duì)高血壓腦出血術(shù)后患者血壓、二次出血發(fā)生率、住院天數(shù)、術(shù)后藥物使用等轉(zhuǎn)歸的影響,為高血壓腦出血術(shù)后臨床優(yōu)化治療的方案作出參考。方法選取山西醫(yī)科大學(xué)第一附屬醫(yī)院急診科2011年8月至2017年1月收治的高血壓腦出血患者,符合納入排除標(biāo)準(zhǔn)73例。按照收治順序分為常規(guī)鎮(zhèn)靜治療組和程序化鎮(zhèn)痛鎮(zhèn)靜治療組,兩組患者再依據(jù)格拉斯哥昏迷量表(glasgow coma scale score,GCS)評(píng)估分組,將患者分為輕(13-15分)、中(9-12分)、重(3-8分)三個(gè)組,輕、中組鎮(zhèn)靜深度采用RASS鎮(zhèn)靜程度評(píng)估表進(jìn)行評(píng)判,目標(biāo)分值為-2~1分;病情重組重點(diǎn)觀察血壓、有無(wú)呼吸抑制、有無(wú)藥物作用致瞳孔縮小、有無(wú)拔管、翻越床欄等煩躁現(xiàn)象,有無(wú)意識(shí)加深。記錄兩組患者不同時(shí)間血壓、煩躁發(fā)生率、二次出血率、相關(guān)藥物的使用情況、術(shù)后ICU住院天數(shù)及總住院天數(shù)等臨床指標(biāo),分析所得結(jié)果。計(jì)量資料間比較采用兩獨(dú)立樣本t檢驗(yàn),計(jì)數(shù)資料間的比較采用c2檢驗(yàn)及Fisher確切概率法,應(yīng)用SPSS 20.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,檢驗(yàn)水準(zhǔn)為0.05。結(jié)果:病情中度組患者血壓程序化鎮(zhèn)痛鎮(zhèn)靜治療組相比于常規(guī)鎮(zhèn)靜治療組在術(shù)后1h、9h、72h測(cè)量數(shù)值有差異(P0.05),其余各組在對(duì)應(yīng)時(shí)間點(diǎn)測(cè)得血壓均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療中程序化鎮(zhèn)痛鎮(zhèn)靜治療組較常規(guī)鎮(zhèn)靜治療組鎮(zhèn)靜藥的使用天數(shù)縮短,差異有統(tǒng)計(jì)學(xué)意義(P0.05),靜脈用降壓藥、脫水藥的使用天數(shù)無(wú)差異(P0.05);兩組煩躁的發(fā)生率有差異(P0.05),程序化鎮(zhèn)痛鎮(zhèn)靜組相對(duì)較低;術(shù)后再出血的發(fā)生率無(wú)差別(P0.05);兩組術(shù)后ICU住院天數(shù)無(wú)差異(P0.05),術(shù)后總住院天數(shù)有差異(P0.05),程序化鎮(zhèn)痛鎮(zhèn)靜組較短。結(jié)論:高血壓腦出血術(shù)后程序化鎮(zhèn)痛鎮(zhèn)靜治療可下調(diào)應(yīng)激起到降壓的作用,有助于控制血壓平穩(wěn),減少煩躁的發(fā)生,相比于常規(guī)鎮(zhèn)靜治療可縮短術(shù)后總住院天數(shù)以及鎮(zhèn)靜藥物的使用天數(shù),對(duì)患者術(shù)后轉(zhuǎn)歸起到積極的作用。
[Abstract]:Objective: to explore the effects of programmed analgesia and sedation therapy on blood pressure, secondary bleeding rate, hospital stay and drug use in patients with hypertensive intracerebral hemorrhage (hypertensive intracerebral hemorrhage).Methods 73 patients with hypertensive intracerebral hemorrhage admitted from August 2011 to January 2017 in the Emergency Department of the first affiliated Hospital of Shanxi Medical University were selected.According to the order of treatment, the patients were divided into routine sedation treatment group and programmed analgesia sedation group. According to Glasgow coma scale score evaluation group, the patients were divided into three groups: light group (13-15 points), middle group (9-12 minutes), heavy group (3-8 points).The depth of sedation in the middle group was evaluated by RASS sedative degree evaluation table, the target score was -2 ~ 1. The recombination of the condition focused on observation of blood pressure, respiratory inhibition, pupil dilatation caused by drugs, extubation of tube, crossing of bed column, and other irritable phenomena.There is a deepening of the unconscious.The blood pressure, the incidence of irritability, the rate of secondary bleeding, the use of related drugs, the days of ICU hospitalization and the total length of hospitalization were recorded in the two groups, and the results were analyzed.Two independent samples t test were used for the comparison of measurement data, and c 2 test and Fisher exact probability method were used for the comparison of counting data. The statistical analysis was carried out by using SPSS 20.0 software, and the test level was 0.05.Results: compared with routine sedation group, there was significant difference in blood pressure programmed analgesia and sedation between moderate group and routine sedation group in 1 hour, 9 h and 72 h after operation (P 0.05), and there was no significant difference in blood pressure in other groups at the corresponding time point (P 0.05), and in the middle stage of treatment, there was no significant difference in blood pressure between the control group and the routine sedative group.The days of sedation in sequential analgesia and sedation group were shorter than those in routine sedation treatment group.The difference was statistically significant (P 0.05). There was no difference in the days of the use of dehydration drugs for intravenous antihypertensive drugs, but there was a difference in the incidence of irritability between the two groups (P 0.05), and the sedation group with programmed analgesia was relatively low.There was no difference in the incidence of postoperative rebleeding (P 0.05), but there was no difference in the days of ICU hospitalization between the two groups (P 0.05), but there was a difference in the total days of hospitalization after operation (P 0.05), and in the group of programmed analgesia sedation was shorter than that in the group of routine analgesia and sedation.Conclusion: programmed analgesia and sedation therapy after hypertensive intracerebral hemorrhage can reduce blood pressure and decrease the occurrence of irritability.Compared with routine sedation therapy, it can shorten the total hospital stay and sedation drug use days, and play a positive role in postoperative outcome.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.12

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