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羟考酮和舒芬太尼对老年人结直肠癌腹腔镜根治术后镇痛效果比较

发布时间:2018-04-19 23:07

  本文选题:羟考酮 + 舒芬太尼 ; 参考:《延边大学》2017年硕士论文


【摘要】:目的分析羟考酮和舒芬太尼对老年人结直肠癌根治术后的镇痛效果的影响。探寻该两种药物对术后静脉自控镇痛的效果比较。方法选择本院收治腹腔镜根治术手术的老年结直肠癌患者80例分为A组和B组,每组40例。全部患者都选取全身麻醉方式进行麻醉。术前均未使用镇静药物,在全麻诱导时,采用1.5-2 mg/kg丙泊酚、3-5 μg/kg芬太尼,0.1-0.12 mg/kg维库溴铵这三种药物,以期达到较好的麻醉效果。且在手术中,用微量泵泵注瑞芬太尼0.3ug/(kg.min)和丙泊酚4-12mg/(kg.h)、间断补充维库溴铵、持续吸入七氧醚让老年患者维持麻醉状态。机械通气潮气量设定为10 ml/kg,呼吸频率为15~20次/分,吸呼比为1:2,监测呼气末二氧化碳分压(PETC02),维持PETC02在35~45mmg。术毕将丙泊酚和瑞芬太尼停止泵注,待患者恢复自主呼吸以新斯的明(0.07mg/kg)配伍阿托品(0.2~0.4mmg)作为肌松拮抗剂以拮抗残余的肌松作用,后将患者送入麻醉苏醒室,所有患者均在苏醒室内拔除气管导管。直到患者完全清醒且在不吸氧时血氧饱和度仍能大于95%超过5分钟才可送返疗区。A组盐酸羟考酮30 mg;B组舒芬太尼100 ug,均溶于100 ml阿扎司琼氯化钠注射液中(阿扎司琼10 mg),持续泵入剂量为每小时2 ml,单次PAC按压追加剂量为2 ml,锁定时间为15分钟,镇痛时间为48h。观察两组苏醒后不同时间点(术后即刻为T0、2h为Tl、4h为T2、12h为T3、24h为T4)的VAS评分、Ramsay镇静评分、是否达到满意镇静状态,并记录48小时内自控镇痛泵追加键实际、有效按压次数,不良反应的发生率。结果根据两组比较观察发现,T0-T2时A组VAS评分较B组有明显升高的现象,差异有统计学意义(P0.05)T3、T4均能达到满意的镇静效果;T1-T4时,B组Ramsay镇静评分明显升高,差异有统计学意义(P0.05)T2-T4时患者均能达到镇静满意状态;48小时内,A组比B组PCA实际、有效按压次数明显增多,差异有统计学意义(P0.05);与B组比较,A组恶心、呕吐、嗜睡发生率较低,差异有统计学意义(P0.05)。综上所述,羟考酮和舒芬太尼都可以达到较好的术后镇痛效果。结论羟考酮和舒芬太尼用于老年人结直肠癌腹腔镜根治术后镇痛是安全有效的,羟考酮不良反应较少,适合临床应用。
[Abstract]:Objective to analyze the analgesic effect of hydroxycodone and sufentanil after radical resection of colorectal cancer in the elderly. To explore the effect of the two drugs on postoperative patient-controlled analgesia. Methods 80 elderly patients with colorectal cancer undergoing laparoscopic radical resection were divided into group A and group B with 40 cases in each group. All patients were anesthetized by general anesthesia. No sedatives were used before operation. In the induction of general anesthesia, the three drugs of propofol of 3-5 渭 g/kg fentanyl of 0.5 渭 g/kg 0.1-0.12 mg/kg of vecuronium bromide were used in order to achieve a better anesthetic effect. During the operation, remifentanil 0.3ugr / kg 路min and propofol 4-12 mg / kg 路h 路min were injected with micropump and vecuronium was added intermittently, sevooxyether was inhaled continuously to maintain anaesthesia in elderly patients. The tidal volume of mechanical ventilation was set at 10 ml / kg, the respiratory rate was 15 ~ 20 times / min, the ratio of inhalation and exhalation was 1: 2, the end expiratory partial pressure of CO _ 2 was monitored and PETC _ (02) was monitored, and the PETC02 was maintained at 35 ~ 45 mm / min. At the end of the operation, propofol and remifentanil were stopped by the pump, and the patients returned to spontaneous respiration with neostigmine (0.07mg / kg) and atropine (0.2mg / kg) as a muscle relaxant antagonist to antagonize the residual muscle relaxation, and then put the patient into the anaesthesia recovery room. All patients were removed tracheal catheter in the recovery room. Until the patient is fully awake and the saturation of blood oxygen can still exceed 95% more than 5 minutes without oxygen inhalation, he can not be returned to the treatment area. Group A is 30 mg of hydroxycodone hydrochloride, group B is sufentanil 100 ug.It is dissolved in 100 ml azasetron sodium chloride injection (Aza). Si Qiong 10 mg / h, continuous pump dose of 2 ml per hour, a single PAC compression dose of 2 ml, locking time of 15 minutes, The analgesia time was 48 hours. To observe the VAS score of sedation at different time points after waking up (T0 h 2 h, T 2 h 4 h, T 2 h 4 h, T 3 h 24 h, T 4), and to record the actual and effective times of pressing the additional key of the self-controlled analgesia pump within 48 hours, whether the score of Ramsay sedation was satisfactory to the sedative state, and to record the number of times of pressing the additional key of self-controlled analgesia pump within 48 hours. Incidence of adverse reactions. Results according to the comparison between the two groups, the VAS score of group A was significantly higher than that of group B at T0-T2, and the difference was statistically significant. The Ramsay sedation score of group B was significantly higher than that of group B at T1-T4. The difference was statistically significant at P0.05T2-T4. The patients in group A were more effective than group B in PCA within 48 hours, and the incidence of nausea, vomiting and lethargy in group A was lower than that in group B (P 0.05), and the incidence of nausea, vomiting and lethargy in group A was lower than that in group B. The difference was statistically significant (P 0.05). To sum up, both hydroxycodone and sufentanil can achieve better postoperative analgesia. Conclusion Hydrocodone and sufentanil are safe and effective for postoperative analgesia in elderly patients with colorectal cancer after laparoscopic radical operation.
【学位授予单位】:延边大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R614;R735.34

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