两种不同体位对甲状腺切除术后恶心呕吐影响的临床观察

发布时间：2018-04-05 02:37

本文选题：术后体位　切入点：PONV　出处：《吉林大学》2014年硕士论文

【摘要】：研究背景：术后恶心呕吐是麻醉及外科手术术后的常见并发症，发生率各家报道不一，病人主诉术后恶心呕吐带来的不适比术后疼痛更为严重。关于预防术后恶心呕吐的发生，国内外学者也采用了很多方法，比如止吐药和糖皮质激素的应用，穴位按压等中医方法，但是关于术后体位对恶心呕吐的影响的研究尚甚少。目的：观察两种不同体位对甲状腺切除术后恶心呕吐的影响。方法：本实验为随机、对照临床实验。经过吉林大学伦理委员会同意，术前患者均签署知情同意书。选取吉林大学第一医院2013年1月至2013年6月行择期甲状腺手术的女性患者400例，ASA分级I或II级，年龄18-65岁，无神经系统疾病，无过敏史或过敏体质者，术前一周内未使用过止吐药及糖皮质激素类药物，全部患者术后均不做自控镇痛。拟行手术患者，随机分为实验组（E组)和对照组（C组），每组各200例。E组术后始终低半卧位（头肩部抬高30°左右），C组术后常规去枕平卧位6h后再垫枕。术前常规禁食水，均无术前用药。患者入手术室后监测无创血压、心电图、脉搏和血氧饱和度。两组患者麻醉诱导、麻醉维持方法均相同。麻醉诱导采用咪达唑仑0.03－0.05mg/kg、芬太尼3－6ug/kg或舒芬太尼0.3－0.6ug/kg、顺式阿曲库铵0.1－0.2mg/kg、依托咪酯0.2－0.3mg/kg。去氮给氧5min后插入气管导管。麻醉维持用丙泊酚4－12mg/kg/h，瑞芬太尼0.2－2ug/kg/h微量泵注。根据手术情况间断给予顺式阿曲库铵0.05－0.1mg/kg。手术结束前15min常规静脉给予昂丹司琼4mg，术毕用新斯的明拮抗残余肌松药，患者意识清醒后，达到拔管指征后拔除气管导管，患者送回病房继续观察，，吸氧6h。观察患者有无PONV，术后2h、6h、12h和24h恶心、呕吐、头痛发生情况，止吐药应用情况及住院天数。结果：恶心呕吐主要发生在术后6－12小时左右。E组包括有晕动史及有PONV史者术后恶心、呕吐及头痛等不适发生率低于C组（P0.05），止吐药的用量、平均住院时间也低于C组（P0.05）。结论：术后采用半卧位可降低PONV的发生率，减少止吐药的应用剂量、住院时间及住院费用。
[Abstract]:Background: postoperative nausea and vomiting is a common complication of anesthesia and surgery.On the prevention of postoperative nausea and vomiting, domestic and foreign scholars have also adopted many methods, such as the use of antiemetic drugs and glucocorticoids, acupoint compression and other traditional Chinese medicine methods, but the effect of postoperatively on nausea and vomiting is still very little research.Objective: to observe the effect of two different postures on nausea and vomiting after thyroidectomy.Methods: this experiment is a randomized, controlled clinical trial.Prior to the approval of the ethics committee of Jilin University, informed consent was signed by the patients before operation.From January 2013 to June 2013, 400 female patients with ASA grade I or II, aged 18-65 years, with no neurological diseases, no history of allergies or allergic constitution, were selected from the first Hospital of Jilin University.No antiemetic drugs or glucocorticoids were used within one week before operation.Patients scheduled for operation were randomly divided into experimental group (group E) and control group (group C). Each group had 200 cases. Group E had a low supine position after operation (head and shoulder elevation of 30 掳or so) and group C routinely removed the occipital supine position for 6 hours after operation.There was no preoperative medication for routine fasting water before operation.Non-invasive blood pressure, electrocardiogram, pulse and oxygen saturation were monitored after entering the operating room.Anesthesia induction and maintenance were the same in both groups.Midazolam 0.03-0.05 mg / kg, fentanyl 3-6ug/kg or sufentanil 0.3-0.6 mg / kg, cis-atracurium 0.1-0.2 mg / kg, etomidate 0.2-0.3 mg / kg.The trachea catheter was inserted after nitrogen removal by oxygen supply 5min.Anesthesia was maintained with propofol 4-12 mg / kg / h, remifentanil 0.2-2ug/kg/h micropump.Cis atracurium 0.05-0.1 mg / kg / kg was given intermittently according to the operation conditions.At the end of operation, 15min was routinely given ondansetron 4 mg. After conscious consciousness, the patients got the indication of extubation and removed the trachea catheter. The patients were sent back to the ward for further observation and oxygen inhalation for 6 h.The incidence of nausea, vomiting, headache, antiemetic drug use and hospital stay were observed.Results: the incidence of nausea and vomiting in group E was lower than that in group C (6 to 12 hours after operation). The incidence of nausea, vomiting and headache in group E was lower than that in group C (P 0.05). The dosage of antiemetic drugs and the average hospital stay were also lower than those in group C (P 0.05).Conclusion: the use of semi-supine postoperatively can reduce the incidence of PONV, the dosage of antiemesis, the time of hospitalization and the cost of hospitalization.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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