帕瑞昔布钠预防性镇痛对开腹手术患者术后镇痛效果的影响

发布时间：2018-04-15 21:17

本文选题：帕瑞昔布钠 + 镇痛　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:观察应用帕瑞昔布钠进行预防性镇痛对行开腹胆囊切除术患者术后镇痛效果的影响。方法:选取择期行胆囊切除术患者60例,随机分为两组,即对照组(C组)和帕瑞昔布钠组(P组),每组30例。每组患者均不用术前药,入室后常规监测心电图(ECG),血压(NIBP),脉搏血氧饱和度(SpO2)。全麻常规诱导后,可视喉镜明视下进行气管插管。术中麻醉维持采取全凭静脉麻醉方式,静脉持续泵入异丙酚和瑞芬太尼,维持术中血压波动不超过基础值的20%。术中补液均液体加温,按晶:胶比2:1比例输入,并视术中出血量调整输液速度。手术开始切皮前20 min:C组静脉注射0.9%生理氯化钠2 ml,P组静脉注射帕瑞昔布钠40 mg。手术关腹前两组患者均给予地佐辛0.08 mg/kg静点,手术缝皮时停止泵注异丙酚和瑞芬太尼,静脉三通连接术后镇痛泵并开启。术毕患者带气管导管,简易呼吸囊辅助呼吸送入恢复室。记录两组患者的苏醒时间、拔管时间、意识恢复时间、拔管时Riker评分(SAS)及寒颤、躁动发生率;记录术后2 h、4 h、8 h、12 h、24 h的疼痛评分(VAS评分),术后镇痛泵按压次数及术后恶心呕吐、头晕、呼吸抑制的发生率。躁动评分采用Riker镇静及躁动评分(SAS),疼痛评分标准采用疼痛视觉模拟评分(VAS)。结果:两组患者苏醒时间、拔管时间、意识恢复时间无显著差异。与C组比较,P组拔管时SAS评分显著低于C组(P0.05)且拔管后躁动发生率P组明显低于C组(P0.05);P组术后各时间点VAS评分均低于C组,且术后镇痛泵按压总次数显著少于C组,两组差异有统计学意义(P0.05)。与C组相比,P组术后恶心呕吐的发生率明显小于C组,结果有统计学意义(P0.05)。结论:帕瑞昔布钠预防性镇痛可降低全麻患者苏醒期躁动的发生率,而且可以减少术后镇痛药物的用量,可以安全、有效的应用于临床。
[Abstract]:Aim: to observe the effect of prophylactic analgesia with paroxib sodium on postoperative analgesia in patients undergoing open cholecystectomy.Methods: sixty patients undergoing elective cholecystectomy were randomly divided into two groups: control group (C group) and paroxib sodium group (30 cases in each group).The patients in each group did not need preoperative medication. The ECG, blood pressure, pulse oxygen saturation and SPO _ 2 were monitored.Tracheal intubation was performed under visual laryngoscope after general anesthesia induction.Intraoperative anesthesia was maintained by total intravenous anesthesia with intravenous infusion of propofol and remifentanil.During the operation, the fluid was heated and the transfusion velocity was adjusted according to the volume of blood loss during the operation according to the ratio of crystal to glue at 2:1.20 min:C before the operation, 0.9% physiological sodium chloride was injected intravenously into group P and 40 mg of paroxib sodium was injected intravenously.The patients in the two groups were given dizosin 0.08 mg/kg statically before operation. Propofol and remifentanil were stopped during suture, and the postoperative analgesic pump was connected with the three-way venous connection and turned on.After operation, the patient with trachea catheter, simple respiratory sac assisted breathing into the recovery room.The recovery time, extubation time, consciousness recovery time, Riker score during extubation, chills and restlessness were recorded in both groups, and the pain scores of 2 h, 4 h, 8 h, 12 h and 24 h after operation were recorded, the number of postoperative analgesic pump compressions and postoperative nausea and vomiting were recorded.The incidence of dizziness and respiratory depression.Riker sedation and restlessness scores were used in restlessness scale and pain score was used as visual analogue score.Results: there was no significant difference in recovery time, extubation time and consciousness recovery time between the two groups.Compared with group C, the SAS score of extubation in group P was significantly lower than that in group C (P 0.05), and the incidence of restlessness after extubation in group P was significantly lower than that in group C (P 0.05). The VAS score of group P was lower than that of group C at each time point after extubation, and the total number of postoperative analgesic pump compression was significantly less than that of group C.The difference between the two groups was statistically significant (P 0.05).Compared with group C, the incidence of postoperative nausea and vomiting in group P was significantly lower than that in group C (P 0.05).Conclusion: the prophylactic analgesia with paroxib sodium can reduce the incidence of restlessness in patients with general anesthesia and reduce the dosage of postoperative analgesic drugs. It can be used safely and effectively in clinical practice.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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