右美托咪定在老年经尿道前列腺电切手术术后镇痛中的应用

发布时间：2018-04-04 17:52

本文选题：右美托咪定　切入点：氟比洛芬酯　出处：《延安大学》2017年硕士论文

【摘要】：目的:良性前列腺增生(BPH)是泌尿外科临床上的常见病、多发病之一,多发生于50岁以上的老年男性。目前经尿道前列腺电切术(Transure—thral Resection of Prostate,TURP)因其对患者打击小,痛苦较少,恢复迅速以及缩短总住院时间等优点,已经逐渐取代传统的开放手术,成为治疗BPH的金标准。老年人由于疾病、社会环境改变等因素在围术期易产生紧张、焦虑和抑郁等消极情绪,降低痛阈,增加术后对疼痛的敏感性,认知改变,影响预后,增加术后并发症从而增加围术期患者自身的痛苦,对手术及围术期管理造成困难。这就要求一个良好的术后镇痛管理。本研究比较右美托咪啶(Dexmedetomidine,Dex)与氟比洛芬酯用于术后镇痛的安全性、不良反应和镇痛满意度,评价Dex用于老年人TURP手术术后镇痛的质量及效果。方法:选取延安大学附属医院2016年6月至2017年1月60例接受TURP手术的患者,ASA I~II级,随机分为Dex+氟比洛芬酯组(A组)和单用氟比洛芬酯(B组),每组30例。两组均使用0.75%左布比卡因行腰硬联合麻醉,麻醉平面控制在T10以下。手术结束后A组给予Dex0.1ug/kg/h+氟比洛芬酯300mg+托烷司琼10mg,配置100ml;B组给予氟比洛芬酯300mg+托烷司琼10mg,配置100ml,设置术后镇痛泵以2ml/h速率,按压2ml/次,锁定时间为15min。主要观察指标:一般情况(两组患者身高、体重、年龄),术前(T0)、术后2小时(T1)、术后4小时(T2)、术后8小时(T3)、术后12小时(T4)、术后24小时(T5)、术后48小时(T6)7个时间点两组患者视觉模拟量表(VAS)评分,Ramsay镇静评分,患者第一次按压镇痛泵的时间、48小时按压镇痛泵次数以及术后需要额外处理的镇痛次数。记录术后并发症,皮肤瘙痒、恶心呕吐、术后寒颤、呼吸抑制发生率、患者满意度和术后护理满意度。次要指标为各个时间点患者的心率(HR)、平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)、脉搏氧饱和度(Sp02)及手术时间。结果:1.两组患者年龄、身高、体重和ASA分级、手术时间上差异均无统计学意义(P0.05);2.术后镇痛方面A组的VAS评分低于B组,患者第一次按压镇痛泵的时间明显延长(P=0.009);3.两组患者Ramsay评分差异有统计学意义(P0.05),A组高于B组;4.两组患者在术后恶心呕吐、术后寒战发生进行统计学比较,差异有统计学意义,A组低于B组;5.两组患者术后血流动力学组内比较,A组血流动力学较B组稳定;6.两组患者在术后护理的满意度评分A组高于B组,差异有统计学意义(P0.05)。结论:Dex可有效的用于经尿道前列腺电切手术术后镇痛,镇静效果和安全性较好,患者血流动力学更加稳定,并发症的发生率有所降低,术后护理满意度高。
[Abstract]:Objective: benign prostatic hyperplasia (BPH) is a common disease in urology.At present, transure-thral Resection of prostate transurethral transurethral resection (TURP) has gradually replaced the traditional open operation as the gold standard for the treatment of BPH because of its advantages of less attack, less pain, rapid recovery and shorter total hospital stay.Because of diseases, social environment changes and other factors, elderly people are prone to produce negative emotions such as tension, anxiety and depression during perioperative period, reduce pain threshold, increase postoperative sensitivity to pain, change cognition, and affect prognosis.Increasing postoperative complications and increasing the pain of perioperative patients make it difficult to manage the operation and perioperative period.This requires a good postoperative analgesia management.The purpose of this study was to compare the safety, adverse reactions and analgesic satisfaction of dexmememedetomidineine and flurbiprofen in postoperative analgesia, and to evaluate the quality and effect of Dex for postoperative analgesia in elderly patients with TURP.Methods: from June 2016 to January 2017, 60 patients undergoing TURP operation in Yan'an University affiliated Hospital were randomly divided into Dex flurbiprofen group (A group) and flurbiprofen group B (30 cases in each group).Both groups were treated with 0.75% levobupivacaine under combined spinal-epidural anesthesia.After operation, group A was given Dex0.1ug/kg/h flurbiprofen ester, 300mg tropisetron 10 mg, group B was given flurbiprofen ester, 300mg tropisetron 10 mg, and postoperative analgesia pump was set up at 2ml/h rate, pressing 2ml/ times, locking time was 15 minutes.Main outcome measures: general condition (height, weight of patients in two groups),The time of the first analgesia pump was 48 hours.Postoperative complications, skin itching, nausea and vomiting, postoperative chills, respiratory depression, patient satisfaction and postoperative nursing satisfaction were recorded.The secondary indexes were heart rate HRV, mean arterial pressure MAPP, SBP, DBP, pulse oxygen saturation (SP02) and operation time.The result is 1: 1.There was no significant difference in age, height, weight, ASA grade and operation time between the two groups.The difference of Ramsay score between the two groups was statistically significant (P 0.05) and higher than that in group B (4. 5%).Two groups of patients in postoperative nausea and vomiting, postoperative shivering were compared statistically, the difference was statistically significant lower in group A than in group B.Comparison of hemodynamics in two groups after operation, hemodynamics in group A was more stable than that in group B (6. 5%).The satisfaction score of postoperative nursing in group A was higher than that in group B, and the difference was statistically significant (P 0.05).ConclusionTwain Dex can be effectively used for postoperative analgesia after transurethral resection of prostate. The sedation effect and safety are better, hemodynamics is more stable, the incidence of complications is lower, and the postoperative nursing satisfaction is high.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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