本文選題：視網(wǎng)膜脫離 + 手術(shù)��； 參考：《成都中醫(yī)藥大學(xué)》2010年博士論文

【摘要】：目的：(1)研究孔源性視網(wǎng)膜脫離(RRD)患者在手術(shù)前后視功能相關(guān)生存質(zhì)量(VRQoL)改變及其影響因素。(2)研究經(jīng)皮穴位電刺激(TEAS)輔助RRD手術(shù)鎮(zhèn)痛作用及相關(guān)機(jī)理,以期發(fā)揮中醫(yī)治療特色,為臨床RRD手術(shù)優(yōu)選鎮(zhèn)痛方法,減輕患者手術(shù)痛苦,提高生存質(zhì)量。 方法：(1)采用視功能損害患者生存質(zhì)量量表(AQoL-DVI)),測(cè)量92例RRD手術(shù)患者手術(shù)前和隨訪(fǎng)期末的VRQoL,并用多元回歸方法分析其影響因素。(2)將40例RRD并行鞏膜扣帶術(shù)(SB)患者隨機(jī)分為局部麻醉組和復(fù)合麻醉組(簡(jiǎn)稱(chēng)復(fù)麻組和局麻組),兩組均用2%利多卡因和0.894%羅哌卡因各3ml行球后及眼輪匝肌麻醉,復(fù)麻組術(shù)中輔以Hans神經(jīng)穴位儀在術(shù)側(cè)合谷和內(nèi)關(guān)行經(jīng)皮穴位電刺激(TEAS)。術(shù)中行心電監(jiān)護(hù),術(shù)畢填寫(xiě)簡(jiǎn)式的McGill疼痛問(wèn)卷表(Short-form of McGill Pain Questionnaire, SF-MPQ),進(jìn)行疼痛度VAS評(píng)分,術(shù)前及術(shù)畢抽取2ml靜脈血,用酶聯(lián)免疫吸附法檢測(cè)血漿β-內(nèi)啡肽和膽囊收縮素八肽(CCK-8)含量,運(yùn)用SPSS13.0統(tǒng)計(jì)軟件對(duì)結(jié)果進(jìn)行分析。 結(jié)果：(1)手術(shù)前AQoL-DVI得分最低的條目均在“社會(huì)活動(dòng)能力”方面。手術(shù)后量表得分明顯提高。手術(shù)引起條目得分改變最大的均在“社會(huì)活動(dòng)能力”。影響手術(shù)前AQoL-DVI量表得分和手術(shù)引起的得分改變的首要獨(dú)立因素分別是患眼手術(shù)前視力和患眼視力改變。(2)復(fù)麻組患者手術(shù)疼痛強(qiáng)度的VAS評(píng)分低于局麻組(P0.05)；情感項(xiàng)和感覺(jué)項(xiàng)總分均低于局麻組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)中麻藥用量低于局麻組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)中復(fù)麻組心率波動(dòng)低于局麻組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。眼心反射陽(yáng)性率低于局麻組。手術(shù)前后血漿β-EP含量比較,兩組間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),局麻組手術(shù)前后血漿β-EP含量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),復(fù)麻組手術(shù)后血漿β-EP含量較術(shù)前增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。局麻組與復(fù)麻組組內(nèi)CCK-8濃度術(shù)后都比術(shù)前增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。但兩組間比較,術(shù)前術(shù)后濃度差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：(1)AQoL-DVI量表可以敏感反映RRD手術(shù)患者VRQoL狀況。術(shù)前患者因RRD對(duì)生活滿(mǎn)意程度急劇下降。手術(shù)后VRQoL,特別是社會(huì)活動(dòng)能力方面,明顯提高。但在完成一些精細(xì)工作和日常家務(wù)活動(dòng)時(shí)仍有困難。通過(guò)提高視力、及時(shí)手術(shù)和避免手術(shù)并發(fā)癥,有利于RRD患者VRQoL的改善。(2)TEAS輔助局麻對(duì)SB具有較好的鎮(zhèn)痛作用,優(yōu)于單純局麻治療,可減少術(shù)中麻藥用量,減少眼心反射發(fā)生率,機(jī)理可能是通過(guò)TEAS聯(lián)合局麻促進(jìn)手術(shù)疼痛患者體內(nèi)β-EP的釋放,達(dá)到鎮(zhèn)痛目的。在手術(shù)應(yīng)激狀態(tài)下,機(jī)體釋放CCK-8增加。但由于個(gè)體差異較大,樣本量較小,TEAS對(duì)CCK-8釋放的影響規(guī)律未能觀察到。有待今后進(jìn)一步探索。
[Abstract]:Objective: to study the changes of visual function related quality of life and its influencing factors in patients with rhegmatogenous retinal detachment (RRD) before and after operation. To select the best analgesic method for clinical RRD operation, alleviate the patient's operation pain and improve the quality of life. Methods: using the quality of Life scale (QOL) in patients with visual impairment, 92 patients with RRD were measured before and at the end of follow-up. The influencing factors were analyzed by multivariate regression method. 40 patients with RRD underwent scleral buckling surgery were randomized. Two groups were divided into two groups: local anesthesia group and local anesthesia group. Both groups were treated with 2% lidocaine and 0.894% ropivacaine respectively for backball and orbicularis oculi anesthesia. In the reanesthesia group, Hans nerve acupoint apparatus was used in the operation of Hegu and Neiguan. Electrocardiogram monitoring was performed during the operation. Short-form of McGill Pain Questionnaire, SF-MPQs were filled out at the end of the operation, and the VAS scores of pain degree were evaluated. Blood samples of 2ml were collected before and after operation. Plasma 尾 -endorphin and cholecystokinin octapeptide (CCK-8) were measured by enzyme-linked immunosorbent assay (Elisa). The results were analyzed by SPSS13.0 software. Results (1) the lowest AQoL-DVI scores before surgery were in social activity. After operation, the score of the scale was improved obviously. The most significant change in the score of items caused by surgery was in social activity. The primary independent factors influencing the score of AQoL-DVI scale before operation and the change of score caused by operation were the visual acuity before operation and the change of visual acuity of affected eyes respectively. The VAS score of postoperative pain intensity in patients with reanesthesia group was lower than that in local anesthesia group (P 0.05), affective items and visual acuity of patients with reanesthesia group were lower than those of local anesthesia group (P < 0.05). The total scores of sensory items were lower than those of local anesthesia group. The difference was statistically significant (P 0.05). The dosage of anesthetic during operation was lower than that in local anesthesia group, and the difference was statistically significant (P 0.05). The heart rate fluctuation was lower in the reanesthesia group than that in the local anesthesia group, and the difference was statistically significant (P 0.05). The positive rate of eye and heart reflex was lower than that of local anesthesia group. There was no significant difference between the two groups in plasma 尾 -EP levels before and after operation, but there was no significant difference in plasma 尾 -EP levels before and after operation in the local anesthesia group (P 0.05). The plasma 尾 -EP level in the reanesthesia group was higher than that in the preoperation group, and the difference was statistically significant (P 0.05). The concentration of CCK-8 in local anesthesia group and reanesthesia group was significantly higher than that before operation (P 0.05). However, there was no significant difference in concentration between the two groups before and after operation (P 0.05). Conclusion the AQoL-DVI scale can reflect the VRQoL status of RRD patients. The degree of life satisfaction of patients with RRD decreased dramatically before operation. After operation, VROL, especially the ability of social activities, was significantly improved. But it is still difficult to do some fine work and routine housework. By improving visual acuity, timely operation and avoiding operative complications, it is beneficial to the improvement of VRQoL in patients with RRD. Teas has a better analgesic effect on SB, which is superior to local anesthesia alone, and can reduce the dosage of anesthetic during operation and the incidence of eye and heart reflex. The mechanism may be that TEAS combined with local anesthesia can promote the release of 尾-EP in patients with postoperative pain. Under the condition of surgical stress, the release of CCK-8 was increased. However, due to the large individual differences, the effect of tea on the release of CCK-8 was not observed. Further exploration is needed in the future.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2010
【分類(lèi)號(hào)】：R774.1

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10 馬福國(guó);經(jīng)皮穴位電刺激對(duì)呼氣末七氟烷濃度及應(yīng)激反應(yīng)的影響[D];青島大學(xué);2009年

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