發(fā)布時(shí)間：2019-03-05 13:43

【摘要】：目的:1.評(píng)價(jià)皮下自控鎮(zhèn)痛和靜脈自控鎮(zhèn)痛兩種不同鎮(zhèn)痛途徑在人工關(guān)節(jié)置換手術(shù)患者中應(yīng)用時(shí)的術(shù)后鎮(zhèn)痛效果;2.評(píng)價(jià)不同劑量舒芬太尼皮下自控鎮(zhèn)痛用于人工關(guān)節(jié)置換術(shù)后的鎮(zhèn)痛效果。方法:120例行人工關(guān)節(jié)置換術(shù)患者隨機(jī)分為六組,其中皮下自控鎮(zhèn)痛(Patient-controlled Subcutaneous Analgesia,PCSA)組:S1組(舒芬太尼3.0μg/kg)20例,S2組(舒芬太尼3.5μg/kg)20例,S3組(舒芬太尼4.0μg/kg)20例,靜脈自控鎮(zhèn)痛(Patient-controlled Intravenous Analgesia,PCIA)組:I1組(舒芬太尼3.0μg/kg)20例,I2組(舒芬太尼3.5μg/kg)20例,I3組(舒芬太尼4.0μg/kg)20例。分別皮下和靜脈連接病人自控鎮(zhèn)痛(Patient Controlled Analgesia,PCA)泵。PCA泵設(shè)置:鎮(zhèn)痛液為舒芬太尼3.0~4.0μg/kg+生理鹽水至100ml,術(shù)后鎮(zhèn)痛維持48小時(shí),自控時(shí)間鎖定15min,自控藥液0.5ml/次。觀察并記錄術(shù)后4h、8h、12h、24h、36h及48h六個(gè)時(shí)間段的疼痛、惡心、嘔吐和皮膚瘙癢等情況。結(jié)果:1、鎮(zhèn)痛評(píng)分(1)組間比較:與S1組比較,S2組、S3組各時(shí)間的鎮(zhèn)痛評(píng)分較低,與I1組比較,I2組、I3組各時(shí)間的鎮(zhèn)痛評(píng)分較低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);S3組、I3組在術(shù)后4h、8h的鎮(zhèn)痛評(píng)分較S2組、I2組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)組內(nèi)比較:與術(shù)后4h比較,I3組、S3組術(shù)后8h鎮(zhèn)痛評(píng)分較高,與術(shù)后12h比較,S1組、I1組術(shù)后24h鎮(zhèn)痛評(píng)分較低,與術(shù)后24h比較,I1組術(shù)后36h鎮(zhèn)痛評(píng)分較低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。2、鎮(zhèn)靜評(píng)分(1)組間比較:與S1組比較,S2組、S3組在術(shù)后4h、8h、12h的鎮(zhèn)靜評(píng)分較高,與I1組比較,I2組、I3組在術(shù)后4h、8h、12h的鎮(zhèn)靜評(píng)分較高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)組內(nèi)比較:與術(shù)后24h比較,I1組在術(shù)后36h鎮(zhèn)靜評(píng)分較高,與術(shù)后36h比較,在術(shù)后48h鎮(zhèn)靜評(píng)分高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);其余各組與前一時(shí)間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3、不良反應(yīng):(1)惡心情況:與S3組比較,S1組、S2組惡心發(fā)生人數(shù)較多,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)嘔吐情況:與S3組比較,S1組、I3組嘔吐發(fā)生人數(shù)較多,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)皮膚瘙癢情況:S組和I組各組組間比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:老年人工關(guān)節(jié)置換術(shù)后4.0μg/kg的舒芬太尼用于皮下自控鎮(zhèn)痛,可以達(dá)到較滿(mǎn)意的鎮(zhèn)痛效果。
[Abstract]:Purpose: 1. To evaluate the analgesic effect of patient-controlled subcutaneous analgesia (PCEA) and patient-controlled intravenous analgesia (PCI) in patients undergoing arthroplasty. To evaluate the analgesic effect of different doses of sufentanil on patients after arthroplasty. Methods: one hundred and twenty patients undergoing artificial joint replacement were randomly divided into six groups: group S _ 1 (sufentanil 3.0 渭 g / kg), group S _ 2 (3.5 渭 g / kg), group S _ 1 (Patient-controlled Subcutaneous Analgesia,PCSA), 20 patients with sufentanil (3.0 渭 g / kg) and group S _ 2 (3.5 渭 g / kg). Group S3 (sufentanil 4.0 渭 g / kg), patient-controlled intravenous analgesia (Patient-controlled Intravenous Analgesia,PCIA) group: group I (3.0 渭 g / kg), group I (3.5 渭 g / kg). Group I (sufentanil 4.0 渭 g / kg) included 20 patients. (Patient Controlled Analgesia,PCA pump: sufentanil 3.0 ~ 4.0 渭 g / kg saline to 100 ml, postoperative analgesia maintained for 48 hours, self-control time locked for 15 minutes. Automatic control liquid 0.5ml/ times. The pain, nausea, vomiting and pruritus were observed and recorded at 4 h, 8 h, 12 h, 24 h, 36 h and 48 h after operation. Results: 1Analgesia score (1): compared with S1 group, S2 group and S3 group, the analgesic score of S2 group and S3 group was lower than that of I1 group, I2 group and I3 group at each time, and the difference was statistically significant (P0.05). The analgesic scores of S1 group, S2 group and S3 group were lower than those of I1 group, I2 group and I3 group (P0.05). The analgesic scores of S3 group and I3 group were lower than those of S2 group and I2 group at 4 h and 8 h after operation (P0.05). (2): compared with postoperative 4h, S3 group had higher analgesia score at 8h after operation, and compared with 12h after operation, the analgesic scores of S3 group were significantly higher than those of S2 group and I2 group (P0.05). The scores of postoperative analgesia in S1 group and I1 group were lower than those in S1 group and I1 group at 24 h after operation, the difference was statistically significant (P0.05). 2, sedation score (1): compared with S1 group, S2 group, S2group, compared with S1 group and S2 group, there was no significant difference between S1 group and I1 group (P0.05). The sedation score of S3 group was higher than that of I1 group, I2 group, I3 group at 4 h, 8 h, 12 h after operation, the difference was statistically significant (P0.05). (2) group: compared with I1 group, I2 group, I3 group had higher sedation score at 4 h, 8 h and 12 h after operation, the difference was statistically significant (P 0.05). The sedation score of I1 group was higher at 36 hours after operation than that at 36 hours after operation, and the difference was statistically significant at 48 hours after operation (P0.05). There was no significant difference between the other groups and the previous time (P0.05). 3. Adverse reactions: (1) nausea: compared with S3 group, S1 group, S2 group had more nausea than S3 group, S1 group and S2 group, the incidence of nausea was higher than that of S3 group, S1 group and S2 group. The difference was statistically significant (P0.05). (2): compared with S3 group, the incidence of vomiting in S1 and I3 groups was higher than that in S3 group. The difference was statistically significant (P0.05). (3) skin itching: there was no significant difference between S group and I group (P0.05). Conclusion: sufentanil (4.0 渭 g / kg) can be used for patient-controlled subcutaneous analgesia in elderly patients after arthroplasty.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R614

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