舒芬太尼自控—靶控输注用于腹腔镜下妇科手术术后镇痛的临床研究

发布时间：2018-05-07 13:54

本文选题：自控-靶控镇痛 + 靶浓度靶控输注　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的探讨应用Tivatrainer药代动力学模拟软件拟合舒芬太尼自控-靶控输注技术(PCA-TCI)在腹腔镜下妇科手术术后镇痛的有效性和安全性。方法36例ASAI-II级择期行腹腔镜下妇科手术的患者,用SPSS软件随机分为自控-靶控组(A)和靶控组(B)二组,每组n=18例。患者术中靶控输注舒芬太尼和异丙酚,应用Tivatainer药代动力学软件拟合患者血浆药物浓度,在血浆靶浓度达到0.1ng/ml (记为T。)开始上镇痛泵。在上泵时(T0)及上泵后T1(30min)、T2 (1h)、T3 (2h)、T4 (4h)、 T5 (6h)、T6(8h)、T7(16h)各时点,记录Prince-Henry镇痛评分、Ramsay镇静评分、生命体征及各时间舒芬太尼用药量和不良反应发生情况,并在T0、T2、T4、T6行血气分析,在各个时间点上取得相对应的舒芬太尼血浆靶浓度值。结果(1)两组患者一般资料基本一致,无统计学差别。(2)两组各时点MAP、HR、RR、SpO2、鼻测PetC02和血气值在正常范围内。(3)两组患者Prince-Henry镇痛评分、Ramsay镇静评分差异无统计学意义。(4)A组术后16小时各时点舒芬太尼用药量明显低于B组,差异有统计学意义。(5)两组患者上泵后舒芬太尼靶浓度各时点组间比较有统计学差异(P0.05)。A组患者靶浓度低于B组,A组患者的有效浓度为0.07±0.03ng/ml。(6)两组患者镇痛过程中均未出现镇痛不足、呼吸抑制、恶心呕吐等不良反应。结论在妇科腔镜手术术后病人镇痛的研究中,自控-TCI与术后靶控镇痛效果区别不大,都能够达到满意的临床镇痛效果,但自控-TCI术后16h舒芬太尼用药量明显减少,能最大限度符合个体化按需给药原则。
[Abstract]:Objective to investigate the efficacy and safety of Tivatrainer pharmacokinetic simulation software fitting sufentanil self-controlled and target-controlled infusion technique (PCA-TCII) for postoperative analgesia after laparoscopic gynecological surgery. Methods Thirty-six patients with ASAI-II grade undergoing elective laparoscopic gynecologic surgery were randomly divided into two groups (n = 18 in each group). The patients were randomly divided into two groups: automatic control and target control group (A) and target control group (B). Sufentanil and propofol were injected intraoperatively by target-controlled infusion. The plasma concentration of sufentanil and propofol was fitted by Tivatainer pharmacokinetic software. The target concentration of sufentanil and propofol reached 0.1ng/ml (T.) Start on the analgesic pump. At each time point, the Prince-Henry analgesia score, the vital signs, the dosage and adverse reactions of sufentanil at each time point were recorded, and the blood gas analysis was performed at T0 / T2T4T6. The corresponding plasma target concentrations of sufentanil were obtained at each time point. Results 1) the general data of the two groups were basically the same. There was no significant difference in Prince-Henry analgesia score and Ramsay sedation score between two groups. The dosage of sufentanil at 16 hours after operation in group A was significantly lower than that in group B. There was significant difference between the two groups in the target concentration of sufentanil after the pump. There was statistical difference in the target concentration of sufentanil between the two groups. The target concentration of group A was lower than the effective concentration of group B (0.07 卤0.03ng / ml. Respiratory inhibition, nausea, vomiting and other adverse reactions. Conclusion in the study of postoperative analgesia of patients undergoing gynecological endoscopic surgery, the effect of patient-controlled TCI and postoperative target-controlled analgesia is not different, both of them can achieve satisfactory clinical analgesic effect, but the dosage of sufentanil at 16 hours after self-controlled TCI is obviously reduced. It can accord with the principle of individualized medicine on demand to the maximum extent.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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