围术期静脉输注利多卡因对胸科手术病人术后镇痛效果的研究

发布时间：2019-02-13 14:49

【摘要】：研究背景：疼痛是一种由组织损伤或者潜在的组织损伤所引起的不愉快的感觉或情感体验。手术后的疼痛是一种在手术后即刻发生的急性的疼痛，是临床上常见的，，需要及时进行处理的症状。在各种类型的外科手术中，胸科术后的疼痛尤为剧烈，这也成为了患者惧怕胸科手术的最主要原因之一。术后疼痛的主要原因有：肋间神经、肌肉韧带以及切口的创伤和胸腔引流管对机体造成的刺激等。手术后的疼痛会直接影响呼吸运动的幅度和咳嗽排痰的过程，造成呼吸道内分泌物大量潴留，继而可能引发肺不张、胸腔积液、胸腔感染等，情况严重者甚至可能会造成呼吸衰竭和死亡。因此及时而有效合理的镇痛不仅能够改善术后患者的呼吸功能，减少术后并发症的发生，而且还可以促进病人从手术的打击中尽快恢复。目前在临床上使用的经静脉患者自控镇痛(PCIA)方法，是胸科术后患者中应用最广泛有效的术后镇痛方法之一，但单一的镇痛方法往往不能够达到理想的镇痛效果，因此使用两种或两种以上的镇痛方法进行复合镇痛日益成为趋势。硬膜外镇痛是目前公认的胸科术后镇痛的金标准，但是其并发症、禁忌症和不良反应在一定程度上限制了该方法在临床上的应用。本文研究的是在胸科手术患者的围术期，静脉输注利多卡因进行超前镇痛以后，观察胸科术后患者经静脉患者自控镇痛(PCIA)的镇痛效果。目的：在胸科手术患者的围术期静脉输注利多卡因，进行超前镇痛以后，观察病人术后经静脉患者自控镇痛（PCIA）的镇痛效果以及对病人术后康复的影响。方法：选择全麻下进行胸科手术的病人120例，随机将其分为2组（n=60）。A组（利多卡因实验组），用药为利多卡因、芬太尼、舒芬太尼、地佐辛、雷莫司琼。B组（对照组），用药为芬太尼、舒芬太尼、地佐辛、雷莫司琼。A、B两组病人均进行术后自控静脉镇痛（PCIA）。所有病人统一手术方法和麻醉方法，两组均采用全凭静脉麻醉。术中、术后按各组镇痛方法进行镇痛。经静脉患者自控镇痛（PCIA）药物为舒芬太尼100ug、地佐辛150mg、雷莫司琼0.6mg，用生理盐水稀释至100ml。然后由另一名不知道分组情况的麻醉医生运用视觉模拟评分法（VAS）来评价病人术后1h、4h、8h、24h、48h、72h的镇痛效果（包括静息、咳嗽时的VAS评分），记录PCIA按压的次数，不良反应，术后并发症，生命体征，镇静、恶心、呕吐的评分和人数。结果： ⒈镇痛评分结果(VAS评分)：在相同时间段两组之间相互比较，（1）静息时的VAS评分，术后1h、4h、8h，A组的镇痛评分与B组有显著差异，有统计学意义（P0.05）；术后24h、48h、72h, A组的镇痛评分与B组无显著差异，无统计学意义（P0.05）；（2）咳嗽时的VAS评分，术后1h、4h、8h、24h，A组的镇痛评分与B组有显著差异，有统计学意义（P0.05）；术后48h、72h， A组的镇痛评分与B组无显著差异，无统计学意义（P0.05）。 2.追加镇痛药物的比较：两组之间各个时间段相互比较，术后1h、4h、8h、24h的按压次数比较，Ｂ组明显多于Ａ组（P0.05），有统计学意义（P0.05）。术后48h、72h的按压次数比较，Ａ组和Ｂ组无显著差异（P0.05）。 3.术后咳嗽、咳痰配合能力的比较：A组患者能够更好的配合咳嗽咳痰，将呼吸道内分泌物排出，Ａ组优于B组。 4.未观察到有关利多卡因的严重不良反应。 5.两组患者的Ramsay镇静评分，术后1h、4h、8h，B组的镇静评分明显低于A组，有统计学意义（P0.05），B组患者镇静效果较差。其余时间段两组患者的镇静评分无显著差异（P0.05）。 6.两组病人术后镇痛的满意度：A组患者术后疼痛刺激较小，A组的满意度优于B组。结论：在胸科手术的围术期静脉输注利多卡因，进行超前镇痛以后，能够增强术后PCIA的镇痛效果，有效缓解术后疼痛，同时减少了术后并发症的发生，并且没有观察到有关利多卡因的严重不良反应，可以安全有效地应用于胸科手术患者。
[Abstract]:Study Background: Pain is an unpleasant feeling or emotional experience caused by tissue damage or potential tissue damage. The post-operative pain is an acute pain that occurs immediately after the procedure, which is clinically common and requires a timely treatment. In various types of surgery, the pain in the thoracic surgery is particularly acute, which has also become the main cause of the patient's fear of the thoracic surgery. I. The primary cause of post-operative pain is the trauma of intercostal nerves, muscle ligaments, and the trauma of the incision and the stimulation of the body. and the like, and the pain after the operation can directly influence the amplitude of the breathing motion and the process of the cough and the sputum, so that the secretion of the secretion in the respiratory tract can be retained, and then the lung can not be caused, the pleural effusion, the chest infection and the like can be caused, and the severe person can even cause the respiratory failure and the death Therefore, the timely and effective and reasonable analgesia can not only improve the respiratory function of the patients after operation, reduce the occurrence of postoperative complications, but also promote the recovery of the patient from the operation of the operation as soon as possible. Complex. The method of self-controlled analgesia (PCIA), which is currently used in clinical use, is one of the most effective and effective methods for postoperative analgesia in patients with thoracic surgery, but a single analgesic method often does not achieve the desired analgesic effect. As a result, the use of two or more analgesic methods for compound analgesia is increasingly becoming the general trend Potential. Epidural pain is a well-recognized standard for postoperative analgesia, but its complications, contraindications and adverse reactions limit the clinical application of this method to a certain extent. In this paper, the analgesic effect of the postoperative patient-controlled analgesia (PCIA) in the patients with thoracic surgery was observed after the perioperative and intravenous injection of lidocaine in the patients with thoracic surgery. Objective: To observe the analgesic effect of the patient-controlled analgesia (PCIA) and the postoperative rehabilitation of the patients after the intravenous infusion of lidocaine in the perioperative period of the patients with thoracic surgery. Methods: 120 patients who underwent thoracic surgery under general anesthesia were randomly divided into two groups (n = 60). A group (group A of lidocaine) was used as lidocaine, fentanyl, sufentanil and zizine. in group B (control group), remifentanil, sufentanil, zizine, The postoperative self-controlled intravenous analgesia was performed in both groups of patients in the group A and B. PCIA). All patients have a unified surgical method and a method of anesthesia, both of which are all used Intravenous anesthesia. Intraoperative and postoperative analgesia The analgesic was performed by the method of intravenous patient self-control and analgesia (PCIA), and the drug was sufentanil 100 ug, desmaxin 150mg, and ramosetron 0. 6mg, and diluted with normal saline. 100ml. Then, another anesthesiologist who did not know the grouping condition used the visual simulation scoring method (VAS) to evaluate the analgesic effect (including the VAS score at rest and cough) for 1h, 4h, 8h, 24h, 48h and 72h after the operation of the patient, and record the number of pressing times and adverse reactions of the PCIA. Postoperative complications, vital signs, sedation, nausea, and vomiting Score and The results were as follows: (1) VAS score at rest, 1 h, 4 h, and 8 h at rest, and there was a significant difference between group A and group B (P <0.05), and 24 hours after operation. The scores of analgesia in group A and group B were no significant difference (P0.05). (2) VAS score at the time of cough, the analgesic score of group A was significantly different from group B, and there was a significant difference between group B and group B (P <0.05). The analgesic scores of group A and group B were no significant difference after operation for 48h and 72h, and there was no statistics. The clinical significance (P 0.05). 2. The comparison of the additional analgesic drugs: the time interval between the two groups was compared with each other, and the number of pressing times for 1h, 4h, 8h and 24h after operation was significantly higher than that in group A (P0.05). The study significance (P0.05). The number of pressing times of 48h and 72h after operation was compared, and the group A and group B did not Significant difference (P0.05). 3. Comparison of postoperative cough and expectoration ability: A group of patients can better cooperate with cough and expectoration, and the respiratory tract The discharge of internal secretion, group A was better than that of group B. The results showed that the sedation score of group B was significantly lower in group A than in group A. The sedative effect of group B was poor in group B, and the rest of the time was the same. There was no significant difference in the sedation score (P0.05). The postoperative pain was less and the degree of satisfaction of group A was better than that of group B. Conclusion: After the intravenous infusion of lidocaine in the perioperative period of the thoracic surgery, the analgesic effect of the post-operative PCIA can be enhanced, the postoperative pain can be relieved, and the occurrence of postoperative complications is also reduced. and no severe lidocaine was observed.
【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】：R655;R614

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