无背景输注的镇痛模式在剖宫产术后病人的应用

发布时间：2018-01-23 09:52

本文关键词： 病人自控镇痛背景输注速度剖宫产术后镇痛效果不良反应　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察并评估无背景输注的镇痛模式应用于剖宫产术后产妇的镇痛效果、用药量及副作用的情况。方法:选择健康无合并症的产妇30名(ASAⅠ~Ⅱ),择期剖宫产手术在腰硬联合麻醉下施行。将30名产妇随机分为两组,对照组采用传统给药模式:单次给药剂量0.5ml,锁定时间10分钟,背景输注速度为2ml/h。试验组采用完全自控无背景输注模式:单次给药剂量1ml,锁定时间10分钟,无背景输注速度。镇痛药均为喷他佐辛150mg+芬太尼0.5mg配置在100ml生理盐水中。术中记录出血量及手术时间。同时两组均在手术结束前15分钟静脉给予30mg喷他佐辛和5mg托烷司琼。术后拔出硬膜外导管,连接PCIA泵,将病人送回病房。记录两组病人术后4h、8h、12h、24h疼痛视觉模拟评分(VAS评分)、镇静程度评分(Ramsay评分)、用药量,记录心动过缓(HR60次/分或比输注前值低20%以下)、低血压(收缩压90 mm Hg或比基础值低20%以下,或舒张压60 mm Hg)、呼吸抑制(呼吸频率8次/分或比基线下降了20%以上)、恶心呕吐、尿潴留(膀胱内充满尿液有尿意但不能排出)等不良反应的发生情况。结果:与对照组相比,试验组在四个时间点的VAS评分及Ramsay评分均无显著性差异。术后4h、8h、24h试验组的用药总量与对照组相比显著减少(P0.05)差异有统计学意义,而术后12h两组用药总量无显著性差异。在术后0-4h试验组用药量(3.47±1.60ml)与对照组(8.20±0.41ml)相比显著性减少差异有统计学意义(P0.05)。而术后4-8h试验组与对照组用药量分别为7.87±2.70ml和8.47±0.55ml,比较无统计学意义(P0.05)。术后8-12h试验组用药量(11.47±3.18ml)显著高于对照组用药量(8.30±0.41ml),差异有统计学意义(P0.05)。术后12-24h试验组(21.73±7.41ml)与对照组(24.40±0.71ml)用药量无统计学差异(P0.05)。与对照组(33.3%)相比,试验组(26.7%)恶心的发生率显著性降低。两组均未出现心动过缓,血压下降,呼吸抑制、尿潴留及呕吐等不良反应。结论:无背景输注的完全自控镇痛模式在剖宫产术后产妇中的应用,既保证了镇痛镇静效果,又降低了用药量及不良反应的发生率。
[Abstract]:Objective: to observe and evaluate the analgesic effect of the analgesic mode without background infusion in the parturient after cesarean section. Methods: 30 healthy women without complications were selected to perform elective cesarean section under combined spinal-epidural anesthesia. 30 parturients were randomly divided into two groups. The control group was treated with traditional administration mode: single dose of 0.5 ml, locking time of 10 minutes. The speed of background infusion was 2 ml / h. The experimental group was given a single dose of 1 ml, and the locking time was 10 minutes. No background infusion speed. Analgesics are sprayed with tarzosin 150 mg. 0.5 mg fentanyl was administered in 100ml saline. Blood loss and operation time were recorded during operation. Both groups were given 30 mg pentazol and 5 mg tropisetron 15 minutes before the end of operation. After operation, the epidural catheter was removed. The patients were connected with PCIA pump and sent back to the ward. The visual analogue score of pain and the score of sedation degree and the score of Ramsay were recorded in the two groups at 4 h, 8 h, 12 h and 24 h after operation. The HR60 times / min of bradycardia or less than 20% times lower than the value before infusion, hypotension (systolic pressure 90mm Hg or lower than 20% below the base value) were recorded. Or diastolic pressure 60mm HgG, respiratory inhibition (respiratory frequency 8 times / min or lower than baseline by more than 20%), nausea and vomiting. Adverse effects of urinary retention (bladder filled with urine but not excreted). Results: compared with control group. There was no significant difference in VAS score and Ramsay score at four time points in the trial group. Compared with the control group, the total amount of drug used in the 24 h trial group decreased significantly (P 0.05). However, there was no significant difference between the two groups at 12 hours after operation, and the dosage in the trial group was 3.47 卤1.60 ml in 0-4 h after operation, and 8.20 卤0.41 ml in the control group. There was significant difference between the two groups (P 0.05), but the dosage of the test group and the control group were 7.87 卤2.70 ml and 8.47 卤0.55 ml respectively at 4-8 hours after operation. There was no significant difference between the two groups (P 0.05). The dosage in the test group was 11.47 卤3.18 ml in 8-12 hours after operation, which was significantly higher than that in the control group (8.30 卤0.41 ml). There was no significant difference in dosage between the trial group (21.73 卤7.41 ml) and the control group (24.40 卤0.71 ml) after 12-24 h operation (P 0.05). Compared with control group (P 0.05). The incidence of nausea in the trial group was significantly lower than that in the control group. There was no bradycardia, decreased blood pressure and respiratory depression in both groups. Conclusion: the application of complete self-controlled analgesia without background in postpartum cesarean section can not only ensure the analgesic effect, but also reduce the amount of drugs used and the incidence of adverse reactions.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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