羟考酮递减法背景输注在胸腔镜肺叶切除患者术后镇痛中的临床效果观察

发布时间：2018-03-19 11:30

本文选题：盐酸羟考酮　切入点：舒芬太尼　出处：《中国内镜杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的评价盐酸羟考酮注射液递减法背景输注在胸腔镜下肺叶切除患者术后镇痛的临床效果。方法 90例胸腔镜下肺叶切除患者,采用随机数字表法将患者随机分为舒芬太尼组(S组)、恒速羟考酮输注组(Q1组)和递减法背景输注羟考酮组(Q2组),每组30例。手术结束前10 min,S组给予舒芬太尼0.10μg/kg,Q1、Q2组给予羟考酮0.10 mg/kg,S组接电子泵舒芬太尼2.00μg/kg(100 ml),背景输注0.03μg/(kg·h),患者自控镇痛(PCA)剂量0.015μg/kg;Q1组羟考酮1.00 mg/kg(100 ml),背景剂量15.00μg/(kg·h),PCA剂量15.00μg/kg;Q2组羟考酮1.00 mg/kg(100 ml)术后第1个12 h背景输注15.00μg/(kg·h),之后每隔12 h减20.00%,PCA剂量15.00μg/kg,所有镇痛泵锁定时间10 min,每小时锁定4次。记录患者手术结束(T0)、拔管时(T1)和拔管后5 min(T2)有流动力学情况,同时记录患者术后2 h(T3)、8 h(T4)、12 h(T5)、24 h(T6)、48 h(T7)的静态数字疼痛评分(NRS)[NRS(R)],NRS(M)(动态NRS评分),Ramsay评分(镇静水平),PCA(次),药物补救次数,药物使用总量,呼吸抑制、恶心、呕吐和皮肤瘙痒等不良反应和患者术后镇痛的满意度。结果 3组患者拔管时平均动脉压(MAP)和心率(HR)均有升高,与手术结束时比较差异有统计学意义(P0.05),3组患者手术结束时、拔管时和拔管后5 min MAP和HR组间比较差异无统计学意义(P0.05);Q1、Q2组术后NRS(R)评分在(T3~5)时点低于S组,NRS(M)评分在(T3~6)时点低于S组(P0.05);Q1、Q2组Ramsay评分在(T3~7)时点高于S组(P0.05);Q1、Q2组患者PCA按压次数、补救药物使用次数、第1和2天睡眠打搅次数均低于S组;Q2组48 h用药总量低于Q1和S组(P0.05);术后恶心呕吐Q2组低于S组(P0.05);术后镇痛患者满意度Q1、Q2组高于S组(P0.05)。结论胸腔镜下肺叶切除患者术后应用羟考酮注射液递减法背景输注能获得满意的镇痛效果,麻醉苏醒平稳,镇痛效果满意,减少了药物用量和降低了不良反应。
[Abstract]:Objective to evaluate the clinical effect of postoperative analgesia in patients undergoing thoracoscopic lobectomy with decreasing background infusion of hydroxycodone hydrochloride injection. Methods 90 patients with thoracoscopic lobectomy were enrolled in this study. The patients were randomly divided into sufentanil group (n = 30), constant rate hydroxycodone infusion group (n = 30) and desfentanil group (n = 30, n = 30). 10 min before operation, sufentanil 0.10 渭 g / kg / kg Q _ 1Q _ 2 was given to patients in the control group. The background infusion was 0.03 渭 g / kg / kg / h, the dose of patient controlled analgesia was 0.015 渭 g / kg / kg ~ (-1) mg/kg(100 / ml, and the background dose was 15.00 渭 g / kg 路kg ~ (-1) mg/kg(100 / h respectively, and the background dose was 15.00 渭 g / kg 路kg ~ (-1) mg/kg(100 / h respectively, and the background dose was 15.00 渭 g / kg 路kg ~ (-1) mg/kg(100 / h. Every 12 hours, the dosage of PCA was 15.00 渭 g / kg, all the analgesic pumps were locked for 10 mins and 4 times per hour. The flow dynamics was recorded at the end of the operation and the extubation of T1) and 5 min after extubation. At the same time, the static digital pain score (NRSs) of the patients 2 hours after operation was recorded. (dynamic NRS score and Ramsay score (sedative level, times of drug recovery, total amount of drug use, respiratory depression, nausea, nausea) were recorded at 2 h after the operation (PCAs of sedative level, times of drug remedy, total amount of drug use, respiratory inhibition, nausea, and total drug use), NRSs and T7) were recorded at the same time (dynamic NRS score and Ramsay score) (sedative level, times of drug remediation, total amount of drug use, respiratory depression, nausea, nausea, T7). Results the mean arterial pressure (MAPP) and heart rate (HRR) increased in the three groups after extubation, and there was a significant difference between the three groups at the end of operation compared with that at the end of operation. There was no significant difference between group MAP and HR at the time of extubation and 5 min after extubation. The score of NRSs in group 2 was lower than that in group S at the time point of T _ 3 ~ (5)) than that in group S (P _ (0.05) Q _ (1) Q _ (2)) was lower than that in group S (P _ (0.05) Q _ (1) Q _ (2)) when compared with that in group S (P _ (0.05) Q _ (1) Q _ (2)), the Ramsay score of group B was significantly higher than that in group S (P _ (0.05) Q _ (1) Q _ (2)). Times of use of remedial drugs, On the 1st and 2nd day, the total amount of drug used in 48 h in group S was lower than that in group S and group Q 2 was lower than that in group Q 1 and group S, the postoperative nausea and vomiting in group Q2 was lower than that in group S (P 0.05), and the satisfaction of postoperative analgesia patients in group Q 1 and group Q 2 was higher than that in group S (P 0.05). Conclusion Pulmonary lobectomy under thoracoscope is better than that in group Q2. The postoperative analgesic effect was satisfactory with the background infusion of hydroxycodone injection decreasing. The anaesthesia recovery is stable, the analgesia effect is satisfactory, the dosage of drugs is reduced and the adverse reaction is reduced.
【作者单位】：浙江大学金华医院(金华市中心医院)麻醉科;
【基金】：金华市科学技术研究计划重点资助项目(No:2014-3-013)
【分类号】：R614

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