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  本文選題：阻塞性睡眠呼吸暫停低通氣綜合征 + 韓式-懸雍垂腭咽成形術�。� 參考：《延安大學》2017年碩士論文

【摘要】：目的:本研究擬對OSAHS行H-UPPP術后的患者霧化吸入利多卡因,并靜脈小量滴注利多卡因,探討利多卡因對患者術后咽喉疼痛、吞咽困難、咽喉腫脹、細胞因子等方面的保護作用,同時對咽喉麻木感等不良反應予以評價。方法:1.將擬住院行H-UPPP術的OSAHS患者隨機分為兩組,分別為對照組和處理組,對照組為30例,處理組為40例。對照組用地塞米松5mg+生理鹽水9ml氧氣霧化吸入,處理組用利多卡因100mg+地塞米松5mg+生理鹽水4ml氧氣霧化吸入,分別在術后麻醉清晰返回病房后即刻(0h)、術后返回病房3h霧化吸入(3h),每次霧化時間30min內(nèi)完成,并分別在返回病房后即刻(0h)、1h(霧化結束后30min)、2h、3h、4h(第二次霧化結束后30min)、5h、6h從疼痛程度、吞咽困難程度、咽喉腫脹程度予以視覺模擬評分(VAS),在1h時予以咽喉麻木感、疼痛/不適緩解感評估。2.處理組在術后24h內(nèi)12h/次靜脈滴注利多卡因,100mg/次,對照組予以同等劑量生理鹽水。對照組和處理組分別在術前24h、術后24h抽血,并用ELisa試劑盒檢測血清細胞因子IL-6、IL-27、IL-33、8-iso-PGF2α和代謝產(chǎn)物25-OH-VD的變化情況。3.記錄應用利多卡因結束后24h內(nèi)患者出現(xiàn)的任何不良反應。結果:1.對照組、處理組術后即刻(0h)疼痛平均分值為5.80±0.76分和6.00±0.91分,霧化后(1h)疼痛平均分值為6.10±0.55分和3.90±1.39分,1h時處理組疼痛分值較對照組顯著降低,差異有統(tǒng)計學意義(P≤0.001)。術后即刻(0h)對照組、處理組吞咽困難平均距離為5.50±0.34cm和5.48±0.35cm,霧化后30 min(1h)吞咽困難平均距離為5.64±0.31cm和3.09±0.42cm,1h時處理組吞咽困難距離較對照組顯著縮短,差異有統(tǒng)計學意義(P≤0.001)。術后即刻(0h)對照組、處理組咽喉腫脹平均距離為7.49±0.42cm和7.58±0.61cm,霧化后30 min(1h)咽喉腫脹平均距離為7.56±0.50cm和3.96±0.46cm,1h時處理組咽喉腫脹距離較對照組顯著縮短,差異有統(tǒng)計學意義(P≤0.001)。在霧化后即刻(1h)對照組有2例疼痛/不適感有一點緩解,其余患者無明顯改善。處理組中有3例小部分緩解,19例已緩解一半,15例有大部分緩解,3例幾乎完全緩解。處理組的緩解率為100%,對照組緩解率為6.67%,差異有統(tǒng)計學意義(P≤0.001)。在霧化后即刻(1h)對照組僅有1例有中度麻木感,2例有輕度麻木感,其余患者均未出現(xiàn)咽喉麻木感覺。處理組中有31例出現(xiàn)了輕度麻木,7例中度麻木,1例出現(xiàn)了重度麻木,1例未出現(xiàn)麻木感,處理組出現(xiàn)麻木感的概率為98%,對照組出現(xiàn)麻木感的概率為10%,差異有統(tǒng)計學意義(P≤0.001)。2.對照組咽喉疼痛、吞咽困難、咽喉腫脹0-6h評分的AUC的平均值分別為39.30±2.51、37.80±1.85、46.34±1.84,處理組咽喉疼痛、吞咽困難、咽喉腫脹0-6h評分的AUC的平均值分別為23.20±3.34、19.26±1.64、26.24±2.82,兩組AUC差異有統(tǒng)計學意義(P≤0.001)。3.對照組與處理組術前血清IL-6分別為1.31±0.03pg/ml和1.31±0.06pg/ml,術后24h分別為3.02±0.08pg/ml和1.40±0.11pg/ml,兩組差異有統(tǒng)計學意義(P≤0.001)。IL-27術前濃度分別為6.40±0.33pg/ml和6.69±0.12pg/ml,術后24h分別為7.78±0.36pg/ml和6.74±0.39pg/ml,兩組差異有統(tǒng)計學意義(P≤0.001)。IL-33術前濃度分別為39.84±1.38pg/ml和38.16±1.51pg/ml,術后24h分別為40.68±1.16pg/ml和33.32±1.51pg/ml,兩組差異有統(tǒng)計學意義(P≤0.001)。8-iso-PGF2α術前濃度分別為0.46±0.02pg/ml和0.17±0.02pg/ml,術后24h分別為8.09±0.47pg/ml和0.46±0.02pg/ml,兩組差異有統(tǒng)計學意義(P≤0.001)。25-OH-VD術前濃度分別為4.61±0.03ng/ml和4.01±0.16ng/ml,術后24h分別為5.01±0.28ng/ml和2.67±0.07ng/ml,兩組差異有統(tǒng)計學意義(P≤0.001)。4.應用利多卡因結束后24內(nèi)未記錄到任何毒性反應。結論:1.利多卡因能顯著緩解OSAHS患者H-UPPP術后0-6h時咽喉疼痛、吞咽困難、咽喉腫脹等術區(qū)不適;2.利多卡因能顯著降低OSAHS患者H-UPPP術后細胞因子IL-6、IL-27、IL-33、8-iso-PGF2α和25-OH-VD的升高,減少術后應激反應;3.OSAHS患者H-UPPP術后應用利多卡因未記錄到任何毒性反應,臨床應用安全有效,值得推廣。
[Abstract]:Objective: To investigate the effects of lidocaine inhalation and intravenous drip of lidocaine on OSAHS patients after H-UPPP operation, and to explore the protective effect of lidocaine on postoperative sore throat, dysphagia, throat swelling and cytokine, and to evaluate the adverse reactions of pharynx and larynx. Methods: 1. will be hospitalized for H-UP The OSAHS patients with PP were randomly divided into two groups, the control group and the treatment group, the control group was 30 cases, the treatment group was 40 cases. The control group was inhaled with dexamethasone 5mg+ saline 9ml oxygen, the treatment group was treated with lidocaine 100mg+ dexamethasone 5mg+ physiological saline 4ml oxygen atomization inhalation, and immediately after the postoperative anesthesia returned to the ward immediately after the operation (0h) respectively. After the operation, 3h atomization inhalation (3H) was returned to the ward, and each time of atomization was completed within 30min, and immediately after returning to the ward (0h), 1H (30min after atomization), 2h, 3h, 4H (30min) and 5h after the second atomization, 6h from the degree of pain, dysphagia, throat swelling degree. The.2. treatment group had 12h/ intravenous drip of lidocaine, 100mg/ times and the same dose of physiological saline in the control group after 24h. The control group and the treatment group were 24h before operation, 24h after operation, and the ELisa reagent box was used to detect the changes of serum cytokine IL-6, IL-27, IL-33,8-iso-PGF2 a, and metabolite 25-OH-VD. In the 1. control group, the average score of immediate (0h) pain in the 1. control group was 5.80 + 0.76 and 6 + 0.91, and the average score of pain after atomization (1H) was 6.10 + 0.55 and 3.90 + 1.39. The pain score of the treatment group was significantly lower than that of the control group, and the difference was statistically significant. Learning significance (P < 0.001). The average distance of dysphagia in the treatment group was 5.50 + 0.34cm and 5.48 + 0.35cm in the treatment group, and the average distance of dysphagia 30 min (1H) after atomization was 5.64 + 0.31cm and 3.09 + 0.42cm, and the dysphagia distance in the treatment group was significantly shorter than that of the control group at 1H (P < < 0.001). The average distance of throat swelling in the treatment group was 7.49 + 0.42cm and 7.58 0.61cm, and the average distance of throat swelling in 30 min (1H) after atomization was 7.56 + 0.50cm and 3.96 + 0.46cm. The throat swelling distance of the treatment group was significantly shorter than that of the control group (P < 0.001). There were 2 cases of pain / discomfort in the control group immediately after atomization (1H). There were 3 minor remission in the treatment group, 19 in half remission, 15 in the treatment group and 3 in almost complete remission. The remission rate of the treatment group was 100% and the control group was 6.67%, the difference was statistically significant (P < 0.001). Only 1 cases in the control group had moderate numbness and 2 cases in the control group after the fogization. There were 31 cases of mild numbness in the treatment group, 7 moderate numbness, 1 cases of severe numbness, 1 cases of numbness, the probability of numbness in the treatment group was 98%, the probability of numbness in the control group was 10%, and the difference was statistically significant (P < 0.001).2. control group. The average value of AUC for throat pain, dysphagia and throat swelling 0-6h score was 39.30 + 2.51,37.80 + 1.85,46.34 + 1.84 respectively. The average value of AUC in the treatment group, throat pain, dysphagia and laryngology swelling 0-6h score was 23.20 + 3.34,19.26 + 1.64,26.24 + 2.82 respectively, two groups of AUC difference was statistically significant (P < < 0.001) and.3. control group and treatment group The preoperative serum IL-6 was 1.31 + 0.03pg/ml and 1.31 + 0.06pg/ml respectively. The postoperative 24h was 3.02 + 0.08pg/ml and 1.40 + 0.11pg/ml respectively. The two groups were statistically significant (P < 0.001). The preoperative concentration was 6.40 + 0.33pg/ml and 6.69 + 0.12pg/ml respectively. The postoperatively 24h was 7.78 + 0.36pg/ and 6.74 +, and the two groups were statistically significant. The preoperative concentration of.IL-33 was 39.84 + 1.38pg/ml and 38.16 + 1.51pg/ml respectively. The postoperative 24h was 40.68 + 1.16pg/ml and 33.32 + 1.51pg/ml respectively. The difference between the two groups was statistically significant (P < 0.001). The preoperative concentration of.8-iso-PGF2 a was 0.46 + 0.02pg/ml and 0.17 + 0.02pg/ml respectively. The 24h was 8.09 + and 0.46 +, respectively, and the difference between two groups was different after operation. Statistical significance (P < 0.001) the preoperative concentration of.25-OH-VD was 4.61 + 0.03ng/ml and 4.01 + 0.16ng/ml respectively, 24h was 5.01 + 0.28ng/ml and 2.67 + 0.07ng/ml, respectively. The two groups were statistically significant (P < 0.001) and.4. application of lidocaine at the end of 24 did not record any toxic reaction. Conclusion: 1. lidocaine can significantly alleviate the OSAHS patients. H-UPPP postoperative 0-6h in the pharynx and larynx pain, dysphagia, throat swelling and other surgical areas discomfort, 2. lidocaine can significantly reduce the growth of cytokines IL-6, IL-27, IL-33,8-iso-PGF2 A and 25-OH-VD after H-UPPP operation in OSAHS patients, and reduce postoperative stress response; 3.OSAHS patients should use lidocaine without any toxic reaction, clinical application after H-UPPP operation. It is safe and effective, and it is worth promoting.
【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R766.9

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