硬膜外不同剂量右美托咪定应用在经尿道前列腺电切术后患者的镇痛效应研究

发布时间：2018-06-02 03:40

本文选题：右美托咪定 + 前列腺电切术　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:探求镇痛的最佳方法是手术病人的急切需求,本研究将针对术后硬膜外镇痛泵中不同剂量右美托咪定配比罗哌卡因的联合应用,观察其对经尿道前列腺电切术患者术后的镇痛效果以及不良反应,以期达到舒适化治疗效果。方法:取60~90岁,ASA分级为Ⅰ~Ⅱ级,择期在腰硬联合麻醉下行经尿道前列腺电切术的男性患者120人。入选病例随机分成四组(n=30):对照组(R)为0.1%罗哌卡因和实验组(RD1,RD2,RD3),RD1组为0.1%罗哌卡因+0.5μg/kg右美托咪定;RD2组为0.1%罗哌卡因+1μg/kg右美托咪定;RD3组为0.1%罗哌卡因+2μg/kg右美托咪定。所有患者术前均常规监测基本生命体征,建立静脉通道,取L3-4间隙,用2%的利多卡因行局部浸润麻醉,在蛛网膜下腔给以0.67%罗哌卡因2.5~3ml,留置硬膜外导管,向头置管4cm,记录麻醉平面,持续监测生命体征情况直到手术结束。术后四组均采取患者自控硬膜外镇痛(PCEA),配制镇痛泵液加生理盐水至150ml,于手术结束时通过硬膜外导管连接镇痛泵,给以负荷剂量6ml,注射速率为3ml/h,严密观察给药后患者反应。手术结束后用医用胶布加固接头,同时指导患者PCEA的使用方法。镇痛不满意时,病人可按压泵上的PCA键追加镇痛泵液,按压一次的剂量为3ml,自动锁定20min,持续48h。观察记录每个病人的手术时长、各项生命体征及追加麻醉药物量等术中其他情况,并观察术后8h、24h和48h患者的VAS评分、Ramsay评分、PCA按压、术后发生膀胱痉挛及追加其他镇痛药物的情况和在泵注时发生的恶心、呕吐、头晕、呼吸不适等不良反应,资料采集后根据分组汇总,用SPSS19.0软件进行数据分析。结果:1.四组VAS评分比较,与对照组R组相比,RD1组无显著性差异,RD2和RD3组镇痛效果可以满足术后需要(VAS评分低、24h内按泵人数减少、显著减少其他镇痛药物使用),差异有统计学意义(p0.05),而两组间无显著性差异。2.四组Ramsay评分比较,与对照组R组相比,RD1组无显著性差异,RD2组和RD3组的镇静效果显著,差异有统计学意义(p0.05),且两组间比较无显著性差异;四组均未发生过度镇静的情况。3.四组术后追加镇痛泵液的情况,在术后8h和24h,与对照组R组相比,RD1组无显著性差异,RD2组和RD3组追加镇痛泵液的发生率显著减少,且差异有统计学意义,(p0.005);而RD2组和RD3组之间无显著性差异;四组在48h的追加镇痛泵液的发生率差异并无显著性。4.四组术后使用其他镇痛药物的情况,与对照组R组相比,RD1组术后使用其他镇痛药物的发生率无显著性差异,但RD2组和RD3组显著减少,且有明显的显著性差异(p0.01);RD2组和RD3组间比较无统计学意义。5.四组术后膀胱痉挛的情况,与对照组R组相比,RD1组无显著性差异,RD2组和RD3组术后膀胱痉挛的发生率均显著下降,且有显著性差异(p0.005),RD2组和RD3组间比较无统计学意义。6.四组综合情况比较,四组病人的一般情况及手术时长的差异无统计学意义,(p0.05)。四组副反应比较,头晕、嗜睡等副反应发生率均低,无统计学意义。结论:1~2μg/kg右美托咪定联合0.1%罗哌卡因能显著提高经尿道前列腺电切术后硬膜外镇痛镇静效应,满足术后镇痛需求,减少膀胱痉挛和副反应的发生。建议经尿道前列腺电切术后应用患者自控硬膜外镇痛,有效剂量为0.1%罗哌卡因与1μg/kg的右美托咪定联合应用具有显著镇静镇痛及最少副作用效果。
[Abstract]:Objective: the best method for the exploration of analgesia is the urgent need of the surgical patients. This study will be aimed at the combined use of ropivacaine with different doses of dexmedetomidine in the postoperative epidural analgesia pump, and observe the analgesic effect and adverse reaction of the patients after the transurethral resection of the prostate in order to achieve the effect of comfort treatment. 60~90 years old and ASA were classified as grade I to II, and 120 men were selected for transurethral resection of the prostate under combined spinal and epidural anesthesia. The selected cases were randomly divided into four groups (n=30): the control group (R) was 0.1% ropivacaine and experimental group (RD1, RD2, RD3), and RD1 group was 0.1% ropivacaine +0.5 g/kg dexmeimidine; RD2 group was 0.1% ropivacaine +1, right and right Metodetonidine; group RD3 was 0.1% ropivacaine +2 g/kg right metomomidin. All patients were routinely monitored for basic vital signs before operation, to establish venous channels, to take L3-4 gaps, to use 2% lidocaine for local infiltration, to give 0.67% ropivacaine in the subarachnoid cavity, to leave the epidural catheter, and to set the head tube 4cm, to record the anesthesia plane, hold the anesthesia plane, hold the anesthesia plane. Continuous monitoring of the vital signs until the end of the operation. Four groups after the operation were taken patient controlled epidural analgesia (PCEA), the analgesic pump was prepared with saline to 150ml, and the analgesic pump was connected through the epidural catheter at the end of the operation. The dose of 6ml was given, the injection rate was 3ml/h, and the patient's reaction was closely observed after the operation. Medical treatment was used after the operation after the operation. When the pain is not satisfactory, the patient can press the PCA key on the pump to add the analgesic pump, press the dose of 3ml, automatically lock the 20min, observe and record the length of each patient's operation, all the vital signs and the amount of anaesthesia, and observe the other conditions, and observe the operation. After 8h, 24h and 48h patients' VAS score, Ramsay score, PCA press, postoperative bladder spasm and additional analgesic drugs, nausea, vomiting, dizziness, and respiratory discomfort occurred during the pump injection, the data were collected and analyzed by SPSS19.0 software. Results: 1. groups of VAS scores were compared with that of the four groups. Compared with group R, there was no significant difference in group RD1. The analgesic effect of group RD2 and RD3 could meet the needs after operation (VAS score was low, the number of pump decreased in 24h), and the difference was statistically significant (P0.05), but there was no significant difference between the two groups, and the Ramsay score of.2. four group was not significant compared with the control group R group, the RD1 group had no significant difference. Difference, the sedative effect of RD2 group and RD3 group was significant (P0.05), and there was no significant difference between the two groups. The four groups did not have excessive sedation,.3. four group.3. after the operation, 8h and 24h, compared with the control group R group, there was no significant difference in the RD1 group, and the RD2 and RD3 groups added the analgesic pump fluid. There was no significant difference in the occurrence rate, and the difference was statistically significant (P0.005), but there was no significant difference between the group RD2 and the RD3 group, and there was no significant difference in the incidence of the four groups in the 48h, and there was no significant difference in the postoperative use of other analgesics in.4. four groups. Compared with the control group R, there was no significant incidence of other analgesic drugs in group RD1 after operation. Sex difference, but the RD2 group and the RD3 group decreased significantly, and there was significant difference (P0.01). There was no statistically significant difference in bladder spasm between group RD2 and RD3 group, and there was no significant difference in RD1 group compared with the control group R group. The incidence of bladder spasm in the RD2 group and the RD3 group decreased significantly (P0.005), and there were significant differences (P0.005), RD. There was no statistically significant difference between the 2 groups and the RD3 group.6. four groups, the general situation of the four groups and the length of the operation were not statistically significant, (P0.05). The side effects of the four groups, dizziness, drowsiness and other side effects were low and no statistical significance. Conclusion: 1~2 mu g/kg dexmedetomidin combined with 0.1% ropivacaine can significantly improve the treatment. The sedative effect of epidural analgesia after urethral resection of the prostate satisfies the postoperative analgesia demand and reduces the occurrence of bladder spasm and side effects. It is suggested that the patient controlled epidural analgesia after transurethral resection of the prostate and the combined use of 0.1% ropivacaine and right metomomidin, which is combined with 1 g/kg, has significant sedative and analgesic and minimal side effects. Effect.
【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】：R614

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