本文選題：地佐辛 + 布托啡諾�。� 參考：《河北北方學院》2017年碩士論文

【摘要】：目的剖宮產(chǎn)率在國內(nèi)外呈現(xiàn)逐年遞增的趨勢,由于孕婦特殊的生理原因,因此術(shù)中廣泛采用椎管內(nèi)麻醉。寒戰(zhàn)是椎管內(nèi)麻醉常見的并發(fā)癥之一,發(fā)生率高達5%~65%。術(shù)中寒戰(zhàn)的發(fā)作會導致產(chǎn)婦產(chǎn)生疼痛、不適以及機體代謝增加等一系列反應,不利于麻醉醫(yī)生準確觀察產(chǎn)婦的各項生理指標,也不利于外科手術(shù)的順利進行。針對以上面臨的困難,臨床上已經(jīng)嘗試了多種輔助用藥,如氯胺酮、芬太尼等,但是由于效果單一或不良反應嚴重等原因,都沒有取得滿意的效果。本研究擬比較地佐辛、布托啡諾復合咪達唑侖對術(shù)中及術(shù)后寒戰(zhàn)的預防和治療作用,選擇針對寒戰(zhàn)安全、有效的預防以及治療方法,建立一套針對寒戰(zhàn)的臨床應對方案。方法本研究以2015年7月-2016年7月期間在聊城市東昌府區(qū)婦幼保健院接受剖宮產(chǎn)的患者為研究對象,根據(jù)納入和排除標準進行一定的篩選,然后通過隨機數(shù)字表法將患者分為預防組(胎兒娩出即刻經(jīng)靜脈給藥)和治療組(胎兒娩出后出現(xiàn)寒戰(zhàn)即經(jīng)靜脈給藥),兩組患者數(shù)量均為100例。預防組隨機分為兩組,Ⅰ組地佐辛(0.1mg/kg)+咪達唑侖(0.03mg/kg)和Ⅱ組布托啡諾(0.01mg/kg)+咪達唑侖(0.03mg/kg),各50例;治療組也隨機分為兩組,即Ⅲ組地佐辛(0.1mg/kg)+咪達唑侖(0.03mg/kg)和IV組布托啡諾(0.01mg/kg)+咪達唑侖(0.03mg/kg),各50例。通過觀察比較各時間點(入室—T0、用藥前—T1、用藥后3min—T2、5min—T3、10min—T4、30min—T5和1h—T6)患者的平均動脈壓(MAP)、心率(HR)、呼吸(RR)、寒戰(zhàn)分級、寒戰(zhàn)治療療效、牽拉反應分級、Ramsay鎮(zhèn)靜評分以及其他不良反應(如惡心嘔吐、呼吸抑制、宮縮痛等),獲得對于預防以及治療寒戰(zhàn)的優(yōu)化用藥方案。結(jié)果(1)預防組和治療組患者的組內(nèi)基線資料比較無統(tǒng)計學差異(P0.05)。(2)預防組中Ⅰ組在T4時間點輕微降低了患者MAP(P0.05),預防組其余時間點以及治療組患者各個時間點組內(nèi)MAP比較無統(tǒng)計學差異(P0.05)。(3)預防組和治療組患者組內(nèi)HR各個時間點比較無統(tǒng)計學差異(P0.05)。(4)在呼吸功能方面,預防組和治療組患者組內(nèi)各個時間點比較無統(tǒng)計學差異(P0.05)。(5)預防組患者組內(nèi)寒戰(zhàn)比較無明顯差異(P0.05);治療組患者IV組用藥消除寒戰(zhàn)時間明顯短于Ⅲ組(P0.01),但治療寒戰(zhàn)有效率方面無明顯差異(P0.05)。(6)預防組內(nèi),Ⅰ組用藥治療牽拉反應明顯優(yōu)于Ⅱ組(P0.05);治療組中,兩組用藥對于牽拉反應治療無明顯差異(P0.05)。(7)預防組中Ⅱ組在T3和T5時間點增加了患者Ramsay鎮(zhèn)靜評分(P0.05),T4時間點明顯增加了患者Ramsay鎮(zhèn)靜評分(P0.01);治療組中IV組在T2時間點增加了患者Ramsay鎮(zhèn)靜評分(P0.05)。結(jié)論在預防寒戰(zhàn)方面,兩組聯(lián)合用藥都具有明顯療效,其中地佐辛+咪達唑侖組牽拉反應和嗜睡反應輕于布托啡諾+咪達唑侖;在治療寒戰(zhàn)方面,布托啡諾+咪達唑侖組消除寒戰(zhàn)時間明顯短于地佐辛+咪達唑侖組。所以,預防寒戰(zhàn)推薦的用藥方案是地佐辛+咪達唑侖;治療寒戰(zhàn)推薦的用藥方案是布托啡諾+咪達唑侖。
[Abstract]:Objective the rate of caesarean section is increasing year by year at home and abroad. Because of the special physiological causes of pregnant women, intraspinal anesthesia is widely used in the operation. Shivering is one of the common complications of intraspinal anesthesia. The incidence of cold war in 5%~65%. can lead to a series of anti pain, discomfort and increase of body metabolism. It is not beneficial for the anesthesiologist to observe all the physiological indexes of the parturient, and it is not conducive to the smooth operation of the surgery. In view of the difficulties faced above, a variety of adjuvant drugs have been tried in clinic, such as ketamine and fentanyl, but the results are not satisfactory because of the single effect or serious adverse reaction. To compare the effect of midazolam and midazolam on the prevention and treatment of intraoperative and postoperative chills, a set of clinical coping strategies aimed at chills, effective prevention and treatment was set up for chills. Methods this study was conducted in the July 2015 -2016 July period in the maternal and child health care hospital in Dongchangfu District, Liaocheng. The patients in the palace were selected and selected according to the inclusion and exclusion criteria. Then the patients were divided into the prevention group (the fetal delivery out of the vein) and the treatment group by the random digital table. The number of the two groups were 100 cases. The prevention group was randomly divided into two groups. Zosin (0.1mg/kg) + midazolam (0.03mg/kg) and group II (0.01mg/kg) + midazolam (0.03mg/kg), each of 50 cases; the treatment group was also randomly divided into two groups, namely, group III Zosin (0.1mg/kg) + midazolam (0.03mg/kg) and IV group Bhutto enphol (0.01mg/kg) + midazolam (0.03mg/kg), each of the 50 cases. The average arterial pressure (MAP), heart rate (HR), respiratory (RR), shivering classification, shivering treatment, traction reaction classification, Ramsay sedation score and other adverse reactions (such as nausea, vomiting, respiratory depression, contraction pain, etc.) were obtained for the prevention and treatment of cold. The average arterial pressure (MAP), heart rate (HR), respiratory (RR), shivering grade, shivering treatment effect, traction reaction classification, Ramsay sedation score and other adverse reactions (such as nausea, vomiting, respiratory depression, contraction pain, etc.) were obtained. Results (1) there was no statistical difference in baseline data between the prevention group and the treatment group (P0.05). (2) the group I in the prevention group decreased the patient MAP (P0.05) slightly at the T4 time point, and the rest time points of the prevention group and the MAP in the treatment group had no statistical difference (P0.05) (3) the prevention group and the prevention group (3) the prevention group and the prevention group. There was no statistical difference in the time points of HR in the treatment group (P0.05). (4) in the respiratory function, there was no significant difference in the time points between the prevention group and the treatment group (P0.05). (5) there was no significant difference (P0.05) in the group of patients in the prevention group (P0.05); in the treatment group, the time of eliminating the chills was significantly shorter in group IV than in group III (P0 .01), but there was no significant difference in the efficiency of the treatment of chills (P0.05). (6) in the prevention group, the traction reaction in group I was obviously better than that in group II (P0.05); in the treatment group, there was no significant difference between the two groups in the treatment of traction reaction (P0.05). (7) the group II group increased the Ramsay sedation score (P0.05) at the time point of T3 and T5 in the prevention group, and the T4 time was clear. The patient's Ramsay sedation score (P0.01) was significantly increased; the group IV in the treatment group increased the patient's Ramsay sedation score (P0.05) at the time point of T2. Conclusion in the prevention of chills, two groups of combined drugs have obvious curative effect. The elimination of chill time in the torphanol + midazolam group was significantly shorter than that of the triazolam + midazolam group. Therefore, the recommended regimen for prevention of chills was triazocine + midazolam, and the recommended regimen for the treatment of chills was Bhutto + midazolam.
【學位授予單位】：河北北方學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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