帕瑞昔布钠和罗哌卡因对妇科腔镜术后镇痛作用比较

发布时间：2018-02-28 16:25

本文关键词： 妇科腹腔镜手术术后镇痛帕瑞昔布钠罗哌卡因　出处：《延边大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析帕瑞昔布钠和罗哌卡因局部麻醉对妇科腹腔镜术后镇痛效果。方法选择本院2015年12月至2016年6月间行妇科腹腔镜手术患者120例,随机分为帕瑞昔布钠组(P组,n=30),罗哌卡因组(R组,n=30),帕瑞昔布钠和罗哌卡因联合组(PR组,n=30)和对照组(C组n=30)。P组患者均在手术结束前半小时静脉注射帕瑞昔布钠40mg,R组分别在二氧化碳气腹建立后和术毕前腹腔内喷洒以及手术结束缝皮前创缘皮下注射0.66%的罗哌卡因10ml,PR组同时接受P组和R组的干预措施,C组在相同时间不接受任何临床干预。所有患者都给予术后自控镇痛泵(PCA泵)并记录比较术毕lh、3h、6h、12h和1d各时间点的视觉模拟疼痛评分(VAS评分)、Ramsay镇静评分(RS评分)、舒适度评分(BCS评分)、PCA泵按压次数、芬太尼总使用量及相关不良反应的发生率。结果术后各时间点记录的各项数据显示,P组、R组及PR组的VAS评分均明显低于C组,并且在术后6h时,PR组的VAS评分低于R组;P组、R组及PR组患者在术后lh时拥有比C组更适宜的镇静评分;术后lh和6h时,P组、R组、PR组的BCS评分均高于C组,并且术后12h和24h时,P组的BCS评分高于PR组;术后各时间点的P组、R组、PR组的PCA泵按压次数均明显低于C组,并且在术后lh,3h,6h,12h时,PR组的PCA泵按压次数均少于P组,术后6h时,PR组的PCA泵按压次数少于R组;术后各时间点的P组、R组、PR组芬太尼总用量均明显少于C组,并且术后lh时的PR组芬太尼总用量少于P组,术后3h时PR组的芬太尼总用量少于P组和R组;术后各时间点的P组、R组、PR组出现恶心、呕吐等不良反应的次数均明显少于C组,各项数据检验结果均有统计学意义(P0.001)。结论术毕前半小时静脉注射帕瑞昔布钠,气腹建立时和术毕时腹腔内喷洒合并手术切口注射罗哌卡因均能够在妇科腹腔镜手术术后疼镇痛过程中明显减少术后芬太尼的总使用量和不良反应,并同时有效缓解患者的术后疼痛,为患者提供各完善的镇痛方案,效果且安全可靠,并且为二者在临床中的广泛应用,提供参考依据。
[Abstract]:Objective to analyze the analgesic effect of paroxibum sodium and ropivacaine on postoperative analgesia after gynecological laparoscopy. Methods 120 patients undergoing gynecologic laparoscopic surgery from December 2015 to June 2016 were selected. They were randomly divided into two groups: paroxib sodium group (n = 30), ropivacaine group (n = 30), ropivacaine group (n = 30) and control group C (n = 30) and control group C (n = 30). All patients in group C were injected with paroxib sodium (40 mg / L) half an hour before the end of operation. After the establishment of carbon dioxide pneumoperitoneum and before the end of operation intraperitoneal spraying and subcutaneous injection of 0.66% ropivacaine 10 ml bun PR group at the same time to receive P and R intervention group C do not receive any clinical at the same time. Intervention. All patients were given PCApump (PCA pump) and recorded visual analogue pain score (VAS) and Ramsay sedation score (Ramsay sedation score), comfort score (BCS score) and PCA pump pressing times at different time points (1hh ~ 3h ~ 6h ~ 12h and 1d) after operation. Results the data recorded at each time point after operation showed that the VAS scores of group R and group PR were significantly lower than those of group C. At 6 h after operation, the VAS score of PR group was lower than that of R group P group R group and PR group group, and the BCS score of P group was higher than that of C group at 1 h and 6 h after operation, and the BCS score of P group was higher than that of group C at 1 h and 6 h after operation, and the BCS score of P group was higher than that of group C at 1 h and 6 h after operation. The BCS score of P group was higher than that of PR group at 12 h and 24 h after operation, the times of PCA pump compression in P group and R group were significantly lower than those in group C at 12 h and 24 h after operation, and the times of PCA pump compression in group P were lower than those in group P at 1 h, 3 h, 6 h and 12 h after operation. At 6 h after operation, the times of PCA pump pressing in PR group were less than those in R group, the total dosage of fentanyl in P group was significantly lower than that in group C at each time point, and the total dosage of fentanyl in PR group was less than that in group P at 1 h after operation. At 3 h after operation, the total dosage of fentanyl in PR group was less than that in P group and R group, and the number of adverse reactions such as nausea and vomiting in P group R group was significantly less than that in C group. The results of each data test were statistically significant (P 0.001). Conclusion the sodium paroxib was injected intravenously half an hour before the end of operation. Both intraperitoneal spraying and incision injection of ropivacaine at the time of establishment of pneumoperitoneum and at the end of operation could significantly reduce the total usage and adverse reactions of fentanyl during postoperative pain and analgesia in gynecological laparoscopic surgery. At the same time, it can effectively relieve the postoperative pain and provide the patients with complete analgesic schemes, the effect is safe and reliable, and they can be widely used in clinical, and provide a reference for the patients.
【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

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