本文選題：鹽酸右美托咪定 + 帕瑞昔布鈉　； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:觀察單獨應用鹽酸右美托咪定和帕瑞昔布鈉或二者聯(lián)合應用在開腹胃腸手術的療效,并評估其對患者圍術期的影響。方法:選取2015年3月至2016年12月于吉林大學中日聯(lián)誼醫(yī)院新民院區(qū)普通外科住院全麻下行開腹胃腸手術患者80例。ASA I-III級,年齡40-70歲,體重45-80kg,全部患者隨機分成四組,每組患者數(shù)量20。常規(guī)全麻誘導后,經(jīng)口明視氣管插管,控制呼吸。術中靜吸復合麻醉,維持BIS值40-60之間。A組:對照組(n=20),誘導前15min,20ml0.9%NaCl溶液,0.7ml/min持續(xù)泵注30min。手術結(jié)束前30min,2ml0.9%NaCl溶液靜推。B組:鹽酸右美托咪定組(n=20),誘導前15min,鹽酸右美托咪定0.6ug/kg負荷量溶于20ml 0.9%NaCl溶液,0.7ml/min持續(xù)泵注30min。手術結(jié)束前30min,2ml 0.9%NaCl溶液靜推。C組:帕瑞昔布鈉組(n=20),誘導前15min,20ml 0.9%NaCl溶液,0.7ml/min持續(xù)泵注30min。手術結(jié)束前30min,40mg帕瑞昔布鈉溶于2ml 0.9%NaCl溶液靜推。D組:聯(lián)合組(n=20),誘導前15min,鹽酸右美托咪定0.6ug/kg負荷量溶于20ml 0.9%NaCl溶液,0.7ml/min持續(xù)泵注30min。手術結(jié)束前30min,40mg帕瑞昔布鈉溶于2ml 0.9%NaCl溶液靜推。手術結(jié)束后連接啟動相同配比的靜脈自控鎮(zhèn)痛泵(PCIA)。觀察并記錄四組患者蘇醒時間(停麻藥到睜眼的時間);拔管時間(停麻藥到拔管的時間);手術時間;術中出血量及尿量;泵藥前5min(T0),泵藥后5min(T1),插管后1min(T2),切皮時(T3),拔管時(T4),五個時刻心率(HR)、平均動脈壓(MAP);術后1h(t1),2h(t2),4h(t3),6h(t4),12h(t5),24h(t6),48h(t7)的疼痛及鎮(zhèn)靜情況(VAS評分及Ramsay鎮(zhèn)靜評分);自控鎮(zhèn)痛泵按壓次數(shù);術后惡心、嘔吐、頭暈、躁動、皮膚瘙癢、呼吸抑制、吻合口漏、術后出血例數(shù)。結(jié)果:(1)比較四組患者的性別、年齡、體重、蘇醒時間、拔管時間、手術時間、術中出血量、術中尿量,無明顯差異(P0.05)。(2)心血管反應:四組患者T0時刻HR、MAP無顯著差異(P0.05)。與T0相比,T1時,輸注右美托咪定的B、D組,HR下降明顯(P0.05),MAP無明顯變化(P0.05)。T2時,四組患者HR、MAP均有上升趨勢,但未輸注右美托咪定的A、C組HR、MAP上升幅度更明顯(P0.05),輸注右美托咪定的B、D組HR、MAP波動幅度輕微,差異無統(tǒng)計學意義(P0.05);T4時,四組患者HR、MAP上升,但未給予帕瑞昔布鈉的A、B組HR、MAP上升幅度更明顯(P0.05)。(3)術后靜止及活動狀態(tài)時疼痛評估(VAS評分)及鎮(zhèn)靜評分(Ramsay鎮(zhèn)靜評分):與A組相比,B、C、D組患者VAS評分顯著降低(P0.01)。與B、C組患者相比,D組患者VAS評分降幅更明顯(P0.05)。與A、C組患者相比,B、D組鎮(zhèn)靜評分高(P0.05)。(4)PCIA按壓次數(shù):與A組相比,B、C、D組患者按壓次數(shù)較少(P0.05)。與B、C組相比,D組患者按壓次數(shù)更少(P0.01)。(5)術后不良反應:與A組患者相比,B、C、D組患者術后躁動的發(fā)生例數(shù)明顯降低(P0.05)。與B、C組患者相比,D組患者發(fā)生術后躁動例數(shù)更少。四組患者其他不良反應發(fā)生率無明顯差異(P0.05)。結(jié)論:1.開腹胃腸手術圍術期無論是單獨應用鹽酸右美托咪定和帕瑞昔布鈉,還是兩者聯(lián)合應用均可以減緩患者術后疼痛,減少PCIA用量。2聯(lián)合應用鹽酸右美托咪定和帕瑞昔布鈉,手術過程血流動力學更平穩(wěn),PCIA用量更少,鎮(zhèn)痛效果更好,不良反應更少,患者滿意度更高。
[Abstract]:Objective: To observe the effect of combined application of dexmeimidine hydrochloride and pareoxib sodium or two groups in laparotomy for gastrointestinal surgery and evaluate its effect on perioperative period. Methods: from March 2015 to December 2016, 80 cases of gastroenteric surgery under general general anesthesia under general general anesthesia under general general anesthesia in the new folk Hospital of Jilin University Sino Japan Friendship Hospital were selected. .ASA I-III, age 40-70, and weight 45-80kg, all the patients were randomly divided into four groups. The number of patients in each group was 20. with general anesthesia induction, the tracheal intubation and control of respiration were carried out. The BIS value 40-60 was maintained in the.A group: the control group (n=20), before induction, 15min, 20ml0.9%NaCl solution, and 0.7ml/min sustained pump 30min. operation ended. Anterior 30min, 2ml0.9%NaCl solution statically push.B group: right metoimidin group (n=20), pre induced 15min, dexmedetomidin 0.6ug/kg load in 20ml 0.9%NaCl solution, 0.7ml/min continuous pumping 30min. before the end of the operation. 30min, 40mg parinoxib sodium dissolved in 2ml 0.9%NaCl solution in group.D before the end of 30min. operation: Joint Group (n=20), pre induced 15min, right metomomidine 0.6ug/kg load in 20ml 0.9%NaCl solution, 0.7ml/min continued before the end of the operation. Connecting the intravenous self controlled analgesia pump (PCIA) with the same proportion, observed and recorded four groups of patients' awakening time (the time of stopping the medicine to the eyes open), the time of extubation (the time of stopping the anesthetic to the extubation), the time of the operation, the amount of bleeding and the amount of urine in the operation, the 5min (T0) before the pump, the 5min (T1) after the pump, the 1min (T2) after the intubation, the T3), the extubation (T4), and the extubation (T4), and five moments. Heart rate (HR), mean arterial pressure (MAP); postoperative 1H (T1), 2h (T2), 4H (T3), 6h (T4), 12h (T5), analgesic pump press times; postoperative nausea, vomiting, dizziness, restlessness, skin itching, respiratory depression, anastomotic leakage, postoperative bleeding cases. Results: (1) compared four groups of patients. Sex, age, weight, time of extubation, operation time, intraoperative bleeding, and urine volume were not significantly different (P0.05). (2) cardiovascular response: there was no significant difference between the four groups of patients at time HR and MAP (P0.05). When compared with T0, T1, the B of right metoimidin, D group, HR decreased significantly (P0.05), and four groups of patients had no obvious changes. AP had an upward trend, but the A of right metodetomidine, C group HR, MAP increased significantly (P0.05), B in right metoimidin, HR in group D, MAP in D, and MAP fluctuated slightly, and the difference was not statistically significant (P0.05). Pain assessment (VAS score) and sedation score (Ramsay sedation score): compared with group A, VAS scores in group B, C and D were significantly lower (P0.01). Compared with B, C group, D group was significantly lower. (4) Less pressure (P0.05). Compared with B, group C, group D patients had less press times (P0.01). (5) postoperative adverse reaction: compared with group A, the number of postoperative restlessness in B, C, and D group was significantly lower (P0.05). Compared with B, C group, patients with postoperative restlessness were less. There was no significant difference in the incidence of other adverse reactions between the four groups. 05). Conclusion: 1. in the perioperative period of laparotomy, both dexmeimidine hydrochloride and pareoxib sodium, or both, can reduce postoperative pain and reduce the amount of PCIA,.2 combined with dexmeimidin and pareoxib sodium, the operation process is more stable, PCIA is less, and the analgesic effect is more effective. Well, less adverse reactions and higher patient satisfaction.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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