不同镇痛方式对全麻吸烟患者围术期镇痛的影响

发布时间：2018-04-13 21:00

  本文选题：镇痛 + 吸烟　； 参考：《大连医科大学》2017年硕士论文

【摘要】：背景:目前国内对于吸烟患者术前大多会常规戒烟,但对于尼古丁依赖患者与其术后疼痛方面的研究仍较少,与此同时我国吸烟的患者并不在少数。长期的尼古丁暴露可以改变疼痛通路的结构与功能,还可能发生尼古丁耐受,导致尼古丁依赖患者对阿片类药物产生耐受,术后阿片类药物用量也相应增加。探究如何为尼古丁依赖患者提供更完善的术后镇痛方案,对于降低术后疼痛程度,减少阿片类药物用量,降低呼吸道并发症的发生率,改善肺功能,提高舒适度,促进术后恢复有着重要的意义。因此本文旨在探讨不同术后镇痛方式对行甲状腺癌根治术吸烟患者的术后疼痛程度及术后阿片类药物用量的影响。方法:选择2016年06月至2016年11月我院收治的80例甲状腺癌患者为研究对象,所有患者均经颈部彩超和CT检查,ASA分级均为I~II级,年龄在40~70岁之间的吸烟男性患者,实验室血生化检验正常,甲状腺功能无明显异常。根据患者FTND评分将所有患者分为2组:低尼古丁依赖组(L组)和高尼古丁依赖组(H组);再将2组患者组内随机分为颈浅丛神经阻滞组(C组)和PCIA组(I组)行不同方式的术后镇痛,即共分为LC、LI、HC、HI 4组,其中HI、LI组每组各22例,HC、LC每组各18例。C组患者在麻醉诱导前行超声引导下双侧颈浅丛神经阻滞,I组患者手术结束时开始使用PCIA镇痛泵。记录术中的舒芬太尼及瑞芬太尼的用量;记录拔管后1分钟(T1)、出PACU前(T2)、手术后24小时(T3)及手术后48小时(T4)患者静息时及咳嗽时疼痛VAS评分、Ramsay镇静评分;记录T1、T2、T3、T4时舒芬太尼用量及其他镇痛药用量;记录患者PONV、颈丛神经阻滞后并发症、术后肺部并发症、LOS等情况。术后其他镇痛药物用量换算为等量的舒芬太尼用量,并计入舒芬太尼总用量。结果:HI、HC组在四个时刻疼痛VAS评分均明显较LI、LC组高,但仅在T1、T2咳嗽时及T3时具有统计学意义(P�e0.05);HI组与HC组及LI组与LC组分别相比较各个时刻的VAS评分并没有明显统计学差异(P�e0.05)。四组在术中舒芬太尼用量的差异没有统计学意义(P�e0.05)。HI组、LI组手术中瑞芬太尼用量分别明显高于HC组、LC组,并具有统计学意义(P�d0.05);HI组与LI组及HC组与LC组手术中瑞芬太尼用量分别比较并没有明显统计学差异(P�d0.05)。HI组在四个时刻舒芬太尼用量均明显较LI组高,但仅在T2、T3、T4时具有统计学意义(P�d0.05);HC组在T2、T3、T4时舒芬太尼用量均较LC组高,但两组在四个时刻均没有统计学差异(P�e0.05);HI组、LI组在四个时刻舒芬太尼用量分别明显高于HC组、LC组,并具有统计学意义(P�d0.05)。HI组、LI组PONV发生率分别高于HC组、LC组,但并没有明显统计学差异(P�e0.05)。四组在不同时刻的Ramsay镇静评分差异无统计学意义(P�e0.05)。四组在LOS上也没有明显差异(P�e0.05)。C组均未发生颈丛神经阻滞后并发症。四组均没有肺部并发症发生。结论:行甲状腺癌根治术的吸烟患者中尼古丁依赖程度越高,其术后疼痛程度越高,术后镇痛药物用量越多;全身麻醉联合颈浅丛神经阻滞可以有效减少吸烟患者术后镇痛药物用量。
[Abstract]:Background: at present the most common smoking patients quit smoking, but for nicotine dependence patients and postoperative pain research is still less, at the same time our country smoking patients is not in the minority. The long-term nicotine exposure can change the structure and function of pain pathways, may also occur in patients with nicotine tolerance, nicotine dependence and tolerance for opioids, postoperative opioid consumption also increased. How to explore analgesic regimen of nicotine dependent patients to provide better postoperative pain to reduce postoperative, reduce the dosage of opioids, reduce respiratory complications, improve lung function, improve comfort, promote the postoperative recovery has important significance. This paper aims to explore the different analgesia methods for resection of thyroid cancer in smoking patients postoperative pain and postoperative. Effect of opioid dosage. Methods: 80 cases of patients with thyroid cancer in 2016 06 months to November 2016 in our hospital as the research object, all patients were treated by cervical ultrasonography and CT examination, ASA were grade I~II, age between 40~70 years old male smoking patients, normal blood biochemical laboratory, thyroid function according to the FTND score in patients with abnormal. All patients were divided into 2 groups: low nicotine dependence group (L group) and high nicotine dependence group (H group); the 2 group patients were randomly divided into superficial cervical plexus block group (C group) and PCIA group (I group) for different ways postoperative analgesia, which is divided into LC, LI, HC, HI 4 group, HI LI group, 22 cases in each group, HC, LC each of the 18 cases of.C patients during general anesthesia induction on ultrasound-guided bilateral superficial cervical plexus block, analgesia pump end started using PCIA group I. Intraoperative sufentanil and Rui 鑺�澶�灏肩殑鐢ㄩ噺;璁板綍鎷旂�″悾�

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