本文選題：氟比洛芬酯 + 術(shù)后鎮(zhèn)痛��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:目前越來越多的患者選擇通過腹腔鏡方式進(jìn)行手術(shù)。與開腹子宮切除術(shù)相比,腹腔鏡入路的子宮切除術(shù)的術(shù)后疼痛并不嚴(yán)重。即便如此,疼痛控制不佳仍是一個(gè)亟待解決的問題,目前有多種關(guān)于控制術(shù)后疼痛的指南但是并沒有一項(xiàng)是與腹腔鏡子宮切除術(shù)相關(guān)的專業(yè)鎮(zhèn)痛指南。目的:探討氟比洛芬酯聯(lián)合噴他佐辛用于腹腔鏡子宮全切術(shù)后鎮(zhèn)痛的療效和不良反應(yīng)的發(fā)生率以及對(duì)患者血流動(dòng)力學(xué)的影響。方法:選取2016年3月至2016年7月就診于長(zhǎng)治醫(yī)學(xué)院附屬和平醫(yī)院婦科,擇期行腹腔鏡子宮切除術(shù)的患者80例,隨機(jī)分為S組和F組術(shù)后實(shí)行靜脈自控鎮(zhèn)痛。S組患者藥物處方為舒芬太尼1ug/kg+噴他佐辛2mg/kg+托烷司瓊10mg;F組為氟比洛芬酯3mg/kg+噴他佐辛2mg/kg+托烷司瓊10mg進(jìn)行術(shù)后鎮(zhèn)痛。觀察項(xiàng)目有:術(shù)后2h、6h、12h、24h、48h患者的視覺模擬評(píng)分(visual analogue scale,VAS)、Ramsay鎮(zhèn)靜評(píng)分(RSS)、血壓和心率以及患者是否會(huì)發(fā)生惡心、嘔吐、口干、便秘、呼吸抑制等并發(fā)癥。結(jié)果:1.VAS水平:F組患者的VAS評(píng)分高于同時(shí)間點(diǎn)S組患者,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.RSS水平:F組患者在T2、T6、T12、T24時(shí)RSS評(píng)分高于高于S組,但差異無統(tǒng)計(jì)學(xué)意義(P㧐0.05),T48時(shí),兩組患者鎮(zhèn)靜評(píng)分無差異。3.術(shù)后鎮(zhèn)痛副作用的結(jié)果:S組患者中有出現(xiàn)術(shù)后惡心嘔吐(Postoperative nausea and vomiting,PONV)者9人;出現(xiàn)低血壓者2人。F組出現(xiàn)惡心者有2人。4.血流動(dòng)力學(xué):兩組患者各時(shí)間點(diǎn)的心率沒有統(tǒng)計(jì)學(xué)差異;在術(shù)后T12和T48時(shí)F組收縮壓顯著高于S組,其余各時(shí)間點(diǎn)兩組血壓差異無統(tǒng)計(jì)學(xué)意義。5.補(bǔ)救治療:F組患者有一人在術(shù)后2h需要注射嗎啡加強(qiáng)鎮(zhèn)痛,S組中沒有患者需要加強(qiáng)鎮(zhèn)痛;S組有1名患者給予甲氧氯普胺10mg對(duì)惡心、嘔吐進(jìn)行治療。結(jié)論:1.氟比洛芬酯聯(lián)合噴他佐辛與舒芬太尼聯(lián)合噴他佐辛相比鎮(zhèn)痛效果無顯著差異、鎮(zhèn)痛滿意。2.氟比洛芬酯聯(lián)合噴他佐辛對(duì)患者鎮(zhèn)靜作用和血流動(dòng)力學(xué)的影響與舒芬太尼聯(lián)合噴他佐辛相似,但PONV的發(fā)生率較舒芬太尼聯(lián)合噴他佐辛組低。
[Abstract]:Background: at present, more and more patients choose laparoscopic surgery. Laparoscopic hysterectomy is less painful than open hysterectomy. Even so, poor pain control is still an urgent problem. There are many guidelines for postoperative pain control, but none of them are related to laparoscopic hysterectomy. Objective: to investigate the effect of flurbiprofen combined with pentazol on postoperative analgesia and the incidence of adverse reactions and hemodynamics in patients undergoing laparoscopic hysterectomy. Methods: from March 2016 to July 2016, 80 patients were selected for elective laparoscopic hysterectomy in the Department of Gynecology, affiliated Peace Hospital of Changzhi Medical College. Patients in group S and group F were randomly divided into two groups: group S and group F were treated with intravenous controlled analgesia after operation. Patients in group S were treated with sufentanil, 1ug/kg, 2mg/kg, tropisetron, 10 mg / g, group F, flurbiprofen ester, 3mg/kg, and 2mg/kg tropisetron 10mg for postoperative analgesia. The observation items were as follows: visual analogue scalescale, Ramsay sedation score, blood pressure, heart rate and complications such as nausea, vomiting, dry mouth, constipation, respiratory depression and so on were observed at 2 h, 6 h, 12 h, 24 h and 48 h after operation. Results 1. The VAS score of the patients in the VAS group was higher than that in the S group at the same time point, but there was no significant difference between the two groups in the scores of RSS at T2T6 and T12T24, but there was no significant difference in the scores of sedation between the two groups at the time of T2T6 and T12T24, but there was no significant difference in sedation score between the two groups. The results of postoperative analgesic side effects were found in 9 patients with postoperative nausea and vomiting PONVN in group S, 2 patients with hypotension in group F, 2 patients with nausea in group F, and 2 patients with nausea in group F (P < 0.05). Hemodynamics: there was no significant difference in heart rate between the two groups at each time point, systolic blood pressure in group F was significantly higher than that in group S at T12 and T48 after operation, and there was no significant difference in blood pressure between the two groups at other time points. 5. There was no need to strengthen analgesia in group S and 1 patient in group S received metoclopramide 10mg to treat nausea and vomiting. Conclusion 1. There was no significant difference in analgesic effect between flurbiprofen and sufentanil. The sedation and hemodynamic effects of flurbiprofen combined with pentazolin were similar to those of sufentanil, but the incidence of PONV was lower than that of sufentanil combined with tazoxin.
【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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