盐酸右美托咪定联合帕瑞昔布钠在开腹胃肠手术患者围术期疗效观察

发布时间：2018-04-21 16:39

本文选题：盐酸右美托咪定 + 帕瑞昔布钠　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:观察单独应用盐酸右美托咪定和帕瑞昔布钠或二者联合应用在开腹胃肠手术的疗效,并评估其对患者围术期的影响。方法:选取2015年3月至2016年12月于吉林大学中日联谊医院新民院区普通外科住院全麻下行开腹胃肠手术患者80例。ASA I-III级,年龄40-70岁,体重45-80kg,全部患者随机分成四组,每组患者数量20。常规全麻诱导后,经口明视气管插管,控制呼吸。术中静吸复合麻醉,维持BIS值40-60之间。A组:对照组(n=20),诱导前15min,20ml0.9%NaCl溶液,0.7ml/min持续泵注30min。手术结束前30min,2ml0.9%NaCl溶液静推。B组:盐酸右美托咪定组(n=20),诱导前15min,盐酸右美托咪定0.6ug/kg负荷量溶于20ml 0.9%NaCl溶液,0.7ml/min持续泵注30min。手术结束前30min,2ml 0.9%NaCl溶液静推。C组:帕瑞昔布钠组(n=20),诱导前15min,20ml 0.9%NaCl溶液,0.7ml/min持续泵注30min。手术结束前30min,40mg帕瑞昔布钠溶于2ml 0.9%NaCl溶液静推。D组:联合组(n=20),诱导前15min,盐酸右美托咪定0.6ug/kg负荷量溶于20ml 0.9%NaCl溶液,0.7ml/min持续泵注30min。手术结束前30min,40mg帕瑞昔布钠溶于2ml 0.9%NaCl溶液静推。手术结束后连接启动相同配比的静脉自控镇痛泵(PCIA)。观察并记录四组患者苏醒时间(停麻药到睁眼的时间);拔管时间(停麻药到拔管的时间);手术时间;术中出血量及尿量;泵药前5min(T0),泵药后5min(T1),插管后1min(T2),切皮时(T3),拔管时(T4),五个时刻心率(HR)、平均动脉压(MAP);术后1h(t1),2h(t2),4h(t3),6h(t4),12h(t5),24h(t6),48h(t7)的疼痛及镇静情况(VAS评分及Ramsay镇静评分);自控镇痛泵按压次数;术后恶心、呕吐、头晕、躁动、皮肤瘙痒、呼吸抑制、吻合口漏、术后出血例数。结果:(1)比较四组患者的性别、年龄、体重、苏醒时间、拔管时间、手术时间、术中出血量、术中尿量,无明显差异(P0.05)。(2)心血管反应:四组患者T0时刻HR、MAP无显著差异(P0.05)。与T0相比,T1时,输注右美托咪定的B、D组,HR下降明显(P0.05),MAP无明显变化(P0.05)。T2时,四组患者HR、MAP均有上升趋势,但未输注右美托咪定的A、C组HR、MAP上升幅度更明显(P0.05),输注右美托咪定的B、D组HR、MAP波动幅度轻微,差异无统计学意义(P0.05);T4时,四组患者HR、MAP上升,但未给予帕瑞昔布钠的A、B组HR、MAP上升幅度更明显(P0.05)。(3)术后静止及活动状态时疼痛评估(VAS评分)及镇静评分(Ramsay镇静评分):与A组相比,B、C、D组患者VAS评分显著降低(P0.01)。与B、C组患者相比,D组患者VAS评分降幅更明显(P0.05)。与A、C组患者相比,B、D组镇静评分高(P0.05)。(4)PCIA按压次数:与A组相比,B、C、D组患者按压次数较少(P0.05)。与B、C组相比,D组患者按压次数更少(P0.01)。(5)术后不良反应:与A组患者相比,B、C、D组患者术后躁动的发生例数明显降低(P0.05)。与B、C组患者相比,D组患者发生术后躁动例数更少。四组患者其他不良反应发生率无明显差异(P0.05)。结论:1.开腹胃肠手术围术期无论是单独应用盐酸右美托咪定和帕瑞昔布钠,还是两者联合应用均可以减缓患者术后疼痛,减少PCIA用量。2联合应用盐酸右美托咪定和帕瑞昔布钠,手术过程血流动力学更平稳,PCIA用量更少,镇痛效果更好,不良反应更少,患者满意度更高。
[Abstract]:Objective: To observe the effect of combined application of dexmeimidine hydrochloride and pareoxib sodium or two groups in laparotomy for gastrointestinal surgery and evaluate its effect on perioperative period. Methods: from March 2015 to December 2016, 80 cases of gastroenteric surgery under general general anesthesia under general general anesthesia under general general anesthesia in the new folk Hospital of Jilin University Sino Japan Friendship Hospital were selected. .ASA I-III, age 40-70, and weight 45-80kg, all the patients were randomly divided into four groups. The number of patients in each group was 20. with general anesthesia induction, the tracheal intubation and control of respiration were carried out. The BIS value 40-60 was maintained in the.A group: the control group (n=20), before induction, 15min, 20ml0.9%NaCl solution, and 0.7ml/min sustained pump 30min. operation ended. Anterior 30min, 2ml0.9%NaCl solution statically push.B group: right metoimidin group (n=20), pre induced 15min, dexmedetomidin 0.6ug/kg load in 20ml 0.9%NaCl solution, 0.7ml/min continuous pumping 30min. before the end of the operation. 30min, 40mg parinoxib sodium dissolved in 2ml 0.9%NaCl solution in group.D before the end of 30min. operation: Joint Group (n=20), pre induced 15min, right metomomidine 0.6ug/kg load in 20ml 0.9%NaCl solution, 0.7ml/min continued before the end of the operation. Connecting the intravenous self controlled analgesia pump (PCIA) with the same proportion, observed and recorded four groups of patients' awakening time (the time of stopping the medicine to the eyes open), the time of extubation (the time of stopping the anesthetic to the extubation), the time of the operation, the amount of bleeding and the amount of urine in the operation, the 5min (T0) before the pump, the 5min (T1) after the pump, the 1min (T2) after the intubation, the T3), the extubation (T4), and the extubation (T4), and five moments. Heart rate (HR), mean arterial pressure (MAP); postoperative 1H (T1), 2h (T2), 4H (T3), 6h (T4), 12h (T5), analgesic pump press times; postoperative nausea, vomiting, dizziness, restlessness, skin itching, respiratory depression, anastomotic leakage, postoperative bleeding cases. Results: (1) compared four groups of patients. Sex, age, weight, time of extubation, operation time, intraoperative bleeding, and urine volume were not significantly different (P0.05). (2) cardiovascular response: there was no significant difference between the four groups of patients at time HR and MAP (P0.05). When compared with T0, T1, the B of right metoimidin, D group, HR decreased significantly (P0.05), and four groups of patients had no obvious changes. AP had an upward trend, but the A of right metodetomidine, C group HR, MAP increased significantly (P0.05), B in right metoimidin, HR in group D, MAP in D, and MAP fluctuated slightly, and the difference was not statistically significant (P0.05). Pain assessment (VAS score) and sedation score (Ramsay sedation score): compared with group A, VAS scores in group B, C and D were significantly lower (P0.01). Compared with B, C group, D group was significantly lower. (4) Less pressure (P0.05). Compared with B, group C, group D patients had less press times (P0.01). (5) postoperative adverse reaction: compared with group A, the number of postoperative restlessness in B, C, and D group was significantly lower (P0.05). Compared with B, C group, patients with postoperative restlessness were less. There was no significant difference in the incidence of other adverse reactions between the four groups. 05). Conclusion: 1. in the perioperative period of laparotomy, both dexmeimidine hydrochloride and pareoxib sodium, or both, can reduce postoperative pain and reduce the amount of PCIA,.2 combined with dexmeimidin and pareoxib sodium, the operation process is more stable, PCIA is less, and the analgesic effect is more effective. Well, less adverse reactions and higher patient satisfaction.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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