围术期口服加巴喷丁胶囊在开胸手术后急慢性疼痛中的应用

发布时间：2018-03-14 03:09

  本文选题：加巴喷丁　切入点：围术期镇痛　出处：《西南医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨围术期应用加巴喷丁胶囊能否减轻开胸手术后急性疼痛的严重程度、术后24h内镇痛药的用量,以及术后2个月慢性疼痛的发生率,神经病理性疼痛的发生率,从而改善患者的生活质量。方法:选择符合纳入和排除标准的患者80例,随机分为四组,实验组G1组、实验组G2组、实验组G3和对照组C组,每组20例。G1组于术前2h口服加巴喷丁胶囊300mg,术后服用安慰剂;G2组于术前2h口服加巴喷丁胶囊300mg,手术后6h服用加巴喷丁100mg,术后第一天开始服用加巴喷丁100mg tid至术后7天;G3组于术前2h口服加巴喷丁胶囊300mg,手术后6h服用加巴喷丁300mg,术后第一天开始服用加巴喷丁300mg至术后7天;C组为对照组,术前术后均给予安慰剂。四组患者切皮前30分钟均静脉滴注帕瑞昔布钠40mg,术后均常规应用静脉镇痛泵PCIA进行术后自控镇痛(配方为:舒芬太尼100ug+托烷司琼5mg,用生理盐水配制成120ml)。观察术后4h、8h、12h、24h、48h、72h、96h和120h病人的疼痛视觉模拟评分(VAS评分);术后24h静脉镇痛药使用量、主动按压bolus次数及术后嗜睡、恶心、呕吐、呼吸困难、眩晕、视物模糊及瘙痒等不良反应;电话随访术后2月患者的慢性疼痛发生率及术后神经病理性疼痛的发生率,并对术后2月患者的焦虑和睡眠质量进行全面评估。结果:1.四组患者的年龄、性别构成、身高、体重、手术时间均无统计学差异(P0.05)。2.四组患者术后VAS评分8h以内均无统计学差异(P0.05),术后8h及以上G1组与C组相比无统计学意义(P0.05);G2、G3组与C组比较有统计学差异,G2、G3组VAS评分小于C组;G2、G3组与G1组相比,G2、G3组术后8h以上VAS评分小于G1组(P0.05);G3组与G2组相比,5天以内的各组VAS评分均无统计学差异(PO.O5)。3.术后24小时内舒芬太尼用量和bolus次数比较,G1组、G2组、G3组与C组比较均有统计学差异,两组数据G1、G2、G3组均小于C组;G2、G3组与G1组比较也有统计学意义,G2、G3组均小于G1组;在G2和G3两组之间比较,无明显统计学意义(P0.05).4.术后不良反应发生率比较,恶心的发生率G1、G2、G3组均低于C组,差异有统计学意义;嗜睡的发生率,C组低于G2、G3组,G1组低于G2组,G2组低于G3组,结果均有统计学意义(P0.05)。5.术后2个月慢性疼痛发生率比较,G1组与C组比较未见明显统计学差异;G2、G3组与C组比较,发生率低于C组,有明显统计学意义(P0.05);G3组与G1组比较,也有统计学差异,慢性疼痛发生率低于G1组;G2、G3组之间比较无统计学差异。神经病理性疼痛比较,G1组与C组比较亦无统计学意义;G2、G3组与C组比较有统计学意义,发生率小于C组;其余无统计学差异。6.术后2个月焦虑和睡眠质量指数比较,G2组、G3组与C组比较有统计学意义,评分小于C组;G2、G3组与G1组比较有统计学差异,评分小于G1组;其余比较无明显统计学意义。结论:1.术前300mg加巴喷丁对术后的急性疼痛评分和术后2个月的慢性疼痛发生率以及神经病理性疼痛发生率没有显著影响,但可以减少术后患者对阿片类药物的需要量。2.术前加术后持续应用加巴喷丁的方式可减少术后急性疼痛的评分和术后2个月慢性疼痛的发生率,且不良反应发生率较少。3.围手术期应用加巴喷丁可减少术后2个月神经病理性疼痛的发生。
[Abstract]:Objective: To investigate the perioperative application of gabapentin to severity of acute pain after thoracic surgery, the amount of 24h in the postoperative analgesic, and 2 months after surgery, the incidence of chronic pain, the incidence of neuropathic pain, so as to improve the quality of life of patients. Methods: 80 cases with inclusion and exclusion the patients were randomly divided into four groups, group G1, group G2, group G3 and control group C, each group of 20 cases in.G1 group, 2h preoperative oral gabapentin capsules 300mg, placebo after operation; group G2 in preoperative 2H plus oral gabapentin 300mg after surgery 6h gabapentin 100mg, after the first day to the 7 day 100mg TID to gabapentin after operation; group G3 in preoperative 2H oral gabapentin 300mg, gabapentin 300mg 6h after surgery, postoperative first day to the 7 day after surgery to gabapentin 300mg; C group of Control group before and after surgery were given placebo. Four groups of patients before skin incision 30 minutes intravenous injection of parecoxib sodium 40mg, postoperative routine use of intravenous analgesia for postoperative patient-controlled analgesia (PCIA formula: 100ug+ sufentanil and tropisetron 5mg with normal saline into 120ml) observation. After 4h, 8h, 12h, 24h, 48h, 72h, 96h and visual analogue score (VAS score) in 120h patients; 24h intravenous analgesic usage after operation, active compression bolus times and postoperative nausea, vomiting, lethargy, dyspnea, dizziness, blurred vision and pruritus and other adverse reactions telephone follow-up; postoperative chronic pain patients in February and the incidence of postoperative neuropathic pain and the incidence of anxiety and sleep quality in February to conduct a comprehensive assessment of patients after operation. Results: 1. of the four groups in age, gender, height, weight, there was no difference in operation time (P0.05).2. four group patients 鏈�鍚嶸AS璇勫垎8h浠ュ唴鍧囨棤缁熻�″�﹀樊寮，

本文编号：1609334