单侧膝关节表面置换术后PCA中芬太尼联合曲马多不同给药模式对镇痛效果的影响

发布时间：2018-04-27 22:46

本文选题：术后镇痛 + 不同给药模式　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的本研究将通过对单膝关节置换术后PCA中芬太尼联合曲马多不同给药模式，观察其镇痛效果，评价其安全性及有效性，探索安全有效的镇痛模式,为临床应用提供参考资料。方法择行单侧膝关节表面置换病人90例，性别不限，年龄50-70岁，排除各种原因不能采用腰麻完成手术的患者(如使用抗凝剂、脊柱畸形、强柱、类风湿关节炎关节等)，随机分为三组(A、B、C组)，，麻醉穿刺成功后5分钟,手术开始前给药并使用PCA泵(A组)；开始手术后给药并使用PCA泵(B组)；A、B组给药配方：（芬太尼0.1mg+曲马多100mg稀释入50ml液体，100ml/h恒速静脉注射）；手术结束后使用PCA泵(C组)，PCA泵配方:芬太尼10ug/kg+曲马多10mg/kg稀释入100ml液体,背景剂量2ml/h，单次剂量0.5ml，锁定时间15min，通过术后VAS评分，BCS舒适评分观察患者术后3h.6h.9h.12h.24h镇痛效果。结果三组镇痛效果VAS评分，BCS舒适评分组内比较差异均无统计学意义（P0.05）。组间比较，VAS评分B组与A组五个时间点均无统计学差异（P0.05）；B组与C组在3h、6h和12h时间点具有统计学差异（P0.05）。BCS评分B组评分明显高于A组、C组,B组与C组比较，3h，6h，9h，12h四个时间点差异具有统计学意义(P0.05)。术后B组不良反应发生率明显低于A组、C组。结论麻醉穿刺成功后5分钟,开始手术后给药并使用PCA泵(B组)；B组给药配方：（芬太尼0.1mg+曲马多100mg稀释入50ml液体，100ml/h恒速静脉注射）；，PCA泵配方:芬太尼10ug/kg+曲马多10mg/kg稀释入100ml液体,背景剂量2ml/h，单次剂量0.5ml，锁定时间15min，通过术后VAS评分，BCS舒适评分观察患者术后3h.6h.9h.12h.24h镇痛效果与术前、术毕相比更为安全、有效，是值得推广的术后PCA给药模式
[Abstract]:Objective to observe the analgesic effect of fentanyl combined with tramadol in PCA after single knee arthroplasty, to evaluate its safety and effectiveness, to explore a safe and effective analgesic model, and to provide references for clinical application. Methods 90 patients with unilateral knee joint surface replacement, male and female, 50-70 years old, who could not be operated on by lumbar anesthesia without any reason (such as anticoagulant, spinal deformity, strong column) were selected. Patients with rheumatoid arthritis were randomly divided into three groups. Administration before operation and use of PCA pump group A; administration of drugs after operation and administration of PCA pump group B and PCA pump group B: (fentanyl 0.1mg tramadol 100mg diluted into 50ml liquid 100ml / h intravenously; PCA pump group C: PCA-PCA-PCA-Fentanyl, 0.1mg tramadol 100mg diluted into 50ml fluid 100ml / h; Fentanyl 0.1mg tramadol 100mg diluted into 50ml liquid 100ml / h intravenously; PCA pump group C Pump formula: fentanyl 10ug/kg tramadol 10mg/kg diluted into 100ml liquid, Background dose was 2 ml / h, single dose was 0.5 ml, locking time was 15 min. Postoperative 3h.6h.9h.12h.24h analgesia was observed by VAS score and comfort score. Results there was no significant difference in VAS score and comfort score between the three groups (P 0.05). There was no statistical difference in VAS score between group B and group A. There was statistical difference between group B and group C at the time points of 3h and 12h. The scores of group B were significantly higher than those of group A (group C) and group B (group B) were significantly higher than those of group A (group A, group C) at 3h, 6h, 9h, 12h, respectively. The point difference was statistically significant (P 0.05). The incidence of adverse reactions in group B was significantly lower than that in group A and C after operation. Conclusion five minutes after anesthesia puncture, the drug was given after the operation and the PCA pump was used in group B and group B was treated with Fentanyl 0.1mg tramadol 100mg diluted into 50ml liquid 100 ml / h intravenously: fentanyl 10ug/kg tramadol 10mg/kg was diluted into 100ml fluid. The results showed that Fentanyl 10ug/kg tramadol 10mg/kg was diluted into 100ml fluid, and Fentanyl 10ug/kg tramadol 10mg/kg was diluted into 100ml fluid. Background dose of 2 ml / h, single dose of 0.5 ml, locking time of 15 minutes. The analgesic effect of postoperative 3h.6h.9h.12h.24h was observed by VAS score and comfort score after operation. Compared with preoperative, the postoperative 3h.6h.9h.12h.24h analgesia was more safe and effective. It is worth popularizing the mode of postoperative PCA administration.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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