發(fā)布時(shí)間：2018-06-02 03:40

  本文選題：右美托咪定 + 前列腺電切術(shù)��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探求鎮(zhèn)痛的最佳方法是手術(shù)病人的急切需求,本研究將針對(duì)術(shù)后硬膜外鎮(zhèn)痛泵中不同劑量右美托咪定配比羅哌卡因的聯(lián)合應(yīng)用,觀察其對(duì)經(jīng)尿道前列腺電切術(shù)患者術(shù)后的鎮(zhèn)痛效果以及不良反應(yīng),以期達(dá)到舒適化治療效果。方法:取60~90歲,ASA分級(jí)為Ⅰ~Ⅱ級(jí),擇期在腰硬聯(lián)合麻醉下行經(jīng)尿道前列腺電切術(shù)的男性患者120人。入選病例隨機(jī)分成四組(n=30):對(duì)照組(R)為0.1%羅哌卡因和實(shí)驗(yàn)組(RD1,RD2,RD3),RD1組為0.1%羅哌卡因+0.5μg/kg右美托咪定;RD2組為0.1%羅哌卡因+1μg/kg右美托咪定;RD3組為0.1%羅哌卡因+2μg/kg右美托咪定。所有患者術(shù)前均常規(guī)監(jiān)測(cè)基本生命體征,建立靜脈通道,取L3-4間隙,用2%的利多卡因行局部浸潤(rùn)麻醉,在蛛網(wǎng)膜下腔給以0.67%羅哌卡因2.5~3ml,留置硬膜外導(dǎo)管,向頭置管4cm,記錄麻醉平面,持續(xù)監(jiān)測(cè)生命體征情況直到手術(shù)結(jié)束。術(shù)后四組均采取患者自控硬膜外鎮(zhèn)痛(PCEA),配制鎮(zhèn)痛泵液加生理鹽水至150ml,于手術(shù)結(jié)束時(shí)通過(guò)硬膜外導(dǎo)管連接鎮(zhèn)痛泵,給以負(fù)荷劑量6ml,注射速率為3ml/h,嚴(yán)密觀察給藥后患者反應(yīng)。手術(shù)結(jié)束后用醫(yī)用膠布加固接頭,同時(shí)指導(dǎo)患者PCEA的使用方法。鎮(zhèn)痛不滿意時(shí),病人可按壓泵上的PCA鍵追加鎮(zhèn)痛泵液,按壓一次的劑量為3ml,自動(dòng)鎖定20min,持續(xù)48h。觀察記錄每個(gè)病人的手術(shù)時(shí)長(zhǎng)、各項(xiàng)生命體征及追加麻醉藥物量等術(shù)中其他情況,并觀察術(shù)后8h、24h和48h患者的VAS評(píng)分、Ramsay評(píng)分、PCA按壓、術(shù)后發(fā)生膀胱痙攣及追加其他鎮(zhèn)痛藥物的情況和在泵注時(shí)發(fā)生的惡心、嘔吐、頭暈、呼吸不適等不良反應(yīng),資料采集后根據(jù)分組匯總,用SPSS19.0軟件進(jìn)行數(shù)據(jù)分析。結(jié)果:1.四組VAS評(píng)分比較,與對(duì)照組R組相比,RD1組無(wú)顯著性差異,RD2和RD3組鎮(zhèn)痛效果可以滿足術(shù)后需要(VAS評(píng)分低、24h內(nèi)按泵人數(shù)減少、顯著減少其他鎮(zhèn)痛藥物使用),差異有統(tǒng)計(jì)學(xué)意義(p0.05),而兩組間無(wú)顯著性差異。2.四組Ramsay評(píng)分比較,與對(duì)照組R組相比,RD1組無(wú)顯著性差異,RD2組和RD3組的鎮(zhèn)靜效果顯著,差異有統(tǒng)計(jì)學(xué)意義(p0.05),且兩組間比較無(wú)顯著性差異;四組均未發(fā)生過(guò)度鎮(zhèn)靜的情況。3.四組術(shù)后追加鎮(zhèn)痛泵液的情況,在術(shù)后8h和24h,與對(duì)照組R組相比,RD1組無(wú)顯著性差異,RD2組和RD3組追加鎮(zhèn)痛泵液的發(fā)生率顯著減少,且差異有統(tǒng)計(jì)學(xué)意義,(p0.005);而RD2組和RD3組之間無(wú)顯著性差異;四組在48h的追加鎮(zhèn)痛泵液的發(fā)生率差異并無(wú)顯著性。4.四組術(shù)后使用其他鎮(zhèn)痛藥物的情況,與對(duì)照組R組相比,RD1組術(shù)后使用其他鎮(zhèn)痛藥物的發(fā)生率無(wú)顯著性差異,但RD2組和RD3組顯著減少,且有明顯的顯著性差異(p0.01);RD2組和RD3組間比較無(wú)統(tǒng)計(jì)學(xué)意義。5.四組術(shù)后膀胱痙攣的情況,與對(duì)照組R組相比,RD1組無(wú)顯著性差異,RD2組和RD3組術(shù)后膀胱痙攣的發(fā)生率均顯著下降,且有顯著性差異(p0.005),RD2組和RD3組間比較無(wú)統(tǒng)計(jì)學(xué)意義。6.四組綜合情況比較,四組病人的一般情況及手術(shù)時(shí)長(zhǎng)的差異無(wú)統(tǒng)計(jì)學(xué)意義,(p0.05)。四組副反應(yīng)比較,頭暈、嗜睡等副反應(yīng)發(fā)生率均低,無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1~2μg/kg右美托咪定聯(lián)合0.1%羅哌卡因能顯著提高經(jīng)尿道前列腺電切術(shù)后硬膜外鎮(zhèn)痛鎮(zhèn)靜效應(yīng),滿足術(shù)后鎮(zhèn)痛需求,減少膀胱痙攣和副反應(yīng)的發(fā)生。建議經(jīng)尿道前列腺電切術(shù)后應(yīng)用患者自控硬膜外鎮(zhèn)痛,有效劑量為0.1%羅哌卡因與1μg/kg的右美托咪定聯(lián)合應(yīng)用具有顯著鎮(zhèn)靜鎮(zhèn)痛及最少副作用效果。
[Abstract]:Objective: the best method for the exploration of analgesia is the urgent need of the surgical patients. This study will be aimed at the combined use of ropivacaine with different doses of dexmedetomidine in the postoperative epidural analgesia pump, and observe the analgesic effect and adverse reaction of the patients after the transurethral resection of the prostate in order to achieve the effect of comfort treatment. 60~90 years old and ASA were classified as grade I to II, and 120 men were selected for transurethral resection of the prostate under combined spinal and epidural anesthesia. The selected cases were randomly divided into four groups (n=30): the control group (R) was 0.1% ropivacaine and experimental group (RD1, RD2, RD3), and RD1 group was 0.1% ropivacaine +0.5 g/kg dexmeimidine; RD2 group was 0.1% ropivacaine +1, right and right Metodetonidine; group RD3 was 0.1% ropivacaine +2 g/kg right metomomidin. All patients were routinely monitored for basic vital signs before operation, to establish venous channels, to take L3-4 gaps, to use 2% lidocaine for local infiltration, to give 0.67% ropivacaine in the subarachnoid cavity, to leave the epidural catheter, and to set the head tube 4cm, to record the anesthesia plane, hold the anesthesia plane, hold the anesthesia plane. Continuous monitoring of the vital signs until the end of the operation. Four groups after the operation were taken patient controlled epidural analgesia (PCEA), the analgesic pump was prepared with saline to 150ml, and the analgesic pump was connected through the epidural catheter at the end of the operation. The dose of 6ml was given, the injection rate was 3ml/h, and the patient's reaction was closely observed after the operation. Medical treatment was used after the operation after the operation. When the pain is not satisfactory, the patient can press the PCA key on the pump to add the analgesic pump, press the dose of 3ml, automatically lock the 20min, observe and record the length of each patient's operation, all the vital signs and the amount of anaesthesia, and observe the other conditions, and observe the operation. After 8h, 24h and 48h patients' VAS score, Ramsay score, PCA press, postoperative bladder spasm and additional analgesic drugs, nausea, vomiting, dizziness, and respiratory discomfort occurred during the pump injection, the data were collected and analyzed by SPSS19.0 software. Results: 1. groups of VAS scores were compared with that of the four groups. Compared with group R, there was no significant difference in group RD1. The analgesic effect of group RD2 and RD3 could meet the needs after operation (VAS score was low, the number of pump decreased in 24h), and the difference was statistically significant (P0.05), but there was no significant difference between the two groups, and the Ramsay score of.2. four group was not significant compared with the control group R group, the RD1 group had no significant difference. Difference, the sedative effect of RD2 group and RD3 group was significant (P0.05), and there was no significant difference between the two groups. The four groups did not have excessive sedation,.3. four group.3. after the operation, 8h and 24h, compared with the control group R group, there was no significant difference in the RD1 group, and the RD2 and RD3 groups added the analgesic pump fluid. There was no significant difference in the occurrence rate, and the difference was statistically significant (P0.005), but there was no significant difference between the group RD2 and the RD3 group, and there was no significant difference in the incidence of the four groups in the 48h, and there was no significant difference in the postoperative use of other analgesics in.4. four groups. Compared with the control group R, there was no significant incidence of other analgesic drugs in group RD1 after operation. Sex difference, but the RD2 group and the RD3 group decreased significantly, and there was significant difference (P0.01). There was no statistically significant difference in bladder spasm between group RD2 and RD3 group, and there was no significant difference in RD1 group compared with the control group R group. The incidence of bladder spasm in the RD2 group and the RD3 group decreased significantly (P0.005), and there were significant differences (P0.005), RD. There was no statistically significant difference between the 2 groups and the RD3 group.6. four groups, the general situation of the four groups and the length of the operation were not statistically significant, (P0.05). The side effects of the four groups, dizziness, drowsiness and other side effects were low and no statistical significance. Conclusion: 1~2 mu g/kg dexmedetomidin combined with 0.1% ropivacaine can significantly improve the treatment. The sedative effect of epidural analgesia after urethral resection of the prostate satisfies the postoperative analgesia demand and reduces the occurrence of bladder spasm and side effects. It is suggested that the patient controlled epidural analgesia after transurethral resection of the prostate and the combined use of 0.1% ropivacaine and right metomomidin, which is combined with 1 g/kg, has significant sedative and analgesic and minimal side effects. Effect.
【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)】：R614

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本文編號(hào)：1967215