程序化镇痛镇静对高血压脑出血术后转归的影响

发布时间：2018-04-16 11:00

本文选题：镇痛 + 镇静　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:探索程序化镇痛镇静治疗对高血压脑出血术后患者血压、二次出血发生率、住院天数、术后药物使用等转归的影响,为高血压脑出血术后临床优化治疗的方案作出参考。方法选取山西医科大学第一附属医院急诊科2011年8月至2017年1月收治的高血压脑出血患者,符合纳入排除标准73例。按照收治顺序分为常规镇静治疗组和程序化镇痛镇静治疗组,两组患者再依据格拉斯哥昏迷量表(glasgow coma scale score,GCS)评估分组,将患者分为轻(13-15分)、中(9-12分)、重(3-8分)三个组,轻、中组镇静深度采用RASS镇静程度评估表进行评判,目标分值为-2~1分;病情重组重点观察血压、有无呼吸抑制、有无药物作用致瞳孔缩小、有无拔管、翻越床栏等烦躁现象,有无意识加深。记录两组患者不同时间血压、烦躁发生率、二次出血率、相关药物的使用情况、术后ICU住院天数及总住院天数等临床指标,分析所得结果。计量资料间比较采用两独立样本t检验,计数资料间的比较采用c2检验及Fisher确切概率法,应用SPSS 20.0软件进行统计学分析,检验水准为0.05。结果:病情中度组患者血压程序化镇痛镇静治疗组相比于常规镇静治疗组在术后1h、9h、72h测量数值有差异(P0.05),其余各组在对应时间点测得血压均无统计学意义(P0.05);治疗中程序化镇痛镇静治疗组较常规镇静治疗组镇静药的使用天数缩短,差异有统计学意义(P0.05),静脉用降压药、脱水药的使用天数无差异(P0.05);两组烦躁的发生率有差异(P0.05),程序化镇痛镇静组相对较低;术后再出血的发生率无差别(P0.05);两组术后ICU住院天数无差异(P0.05),术后总住院天数有差异(P0.05),程序化镇痛镇静组较短。结论:高血压脑出血术后程序化镇痛镇静治疗可下调应激起到降压的作用,有助于控制血压平稳,减少烦躁的发生,相比于常规镇静治疗可缩短术后总住院天数以及镇静药物的使用天数,对患者术后转归起到积极的作用。
[Abstract]:Objective: to explore the effects of programmed analgesia and sedation therapy on blood pressure, secondary bleeding rate, hospital stay and drug use in patients with hypertensive intracerebral hemorrhage (hypertensive intracerebral hemorrhage).Methods 73 patients with hypertensive intracerebral hemorrhage admitted from August 2011 to January 2017 in the Emergency Department of the first affiliated Hospital of Shanxi Medical University were selected.According to the order of treatment, the patients were divided into routine sedation treatment group and programmed analgesia sedation group. According to Glasgow coma scale score evaluation group, the patients were divided into three groups: light group (13-15 points), middle group (9-12 minutes), heavy group (3-8 points).The depth of sedation in the middle group was evaluated by RASS sedative degree evaluation table, the target score was -2 ~ 1. The recombination of the condition focused on observation of blood pressure, respiratory inhibition, pupil dilatation caused by drugs, extubation of tube, crossing of bed column, and other irritable phenomena.There is a deepening of the unconscious.The blood pressure, the incidence of irritability, the rate of secondary bleeding, the use of related drugs, the days of ICU hospitalization and the total length of hospitalization were recorded in the two groups, and the results were analyzed.Two independent samples t test were used for the comparison of measurement data, and c 2 test and Fisher exact probability method were used for the comparison of counting data. The statistical analysis was carried out by using SPSS 20.0 software, and the test level was 0.05.Results: compared with routine sedation group, there was significant difference in blood pressure programmed analgesia and sedation between moderate group and routine sedation group in 1 hour, 9 h and 72 h after operation (P 0.05), and there was no significant difference in blood pressure in other groups at the corresponding time point (P 0.05), and in the middle stage of treatment, there was no significant difference in blood pressure between the control group and the routine sedative group.The days of sedation in sequential analgesia and sedation group were shorter than those in routine sedation treatment group.The difference was statistically significant (P 0.05). There was no difference in the days of the use of dehydration drugs for intravenous antihypertensive drugs, but there was a difference in the incidence of irritability between the two groups (P 0.05), and the sedation group with programmed analgesia was relatively low.There was no difference in the incidence of postoperative rebleeding (P 0.05), but there was no difference in the days of ICU hospitalization between the two groups (P 0.05), but there was a difference in the total days of hospitalization after operation (P 0.05), and in the group of programmed analgesia sedation was shorter than that in the group of routine analgesia and sedation.Conclusion: programmed analgesia and sedation therapy after hypertensive intracerebral hemorrhage can reduce blood pressure and decrease the occurrence of irritability.Compared with routine sedation therapy, it can shorten the total hospital stay and sedation drug use days, and play a positive role in postoperative outcome.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

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