氟比洛芬酯联合喷他佐辛用于腹腔镜子宫切除术患者术后镇痛效果的观察

发布时间：2018-06-18 12:11

本文选题：氟比洛芬酯 + 术后镇痛　；参考：《山西医科大学》2017年硕士论文

【摘要】：背景:目前越来越多的患者选择通过腹腔镜方式进行手术。与开腹子宫切除术相比,腹腔镜入路的子宫切除术的术后疼痛并不严重。即便如此,疼痛控制不佳仍是一个亟待解决的问题,目前有多种关于控制术后疼痛的指南但是并没有一项是与腹腔镜子宫切除术相关的专业镇痛指南。目的:探讨氟比洛芬酯联合喷他佐辛用于腹腔镜子宫全切术后镇痛的疗效和不良反应的发生率以及对患者血流动力学的影响。方法:选取2016年3月至2016年7月就诊于长治医学院附属和平医院妇科,择期行腹腔镜子宫切除术的患者80例,随机分为S组和F组术后实行静脉自控镇痛。S组患者药物处方为舒芬太尼1ug/kg+喷他佐辛2mg/kg+托烷司琼10mg;F组为氟比洛芬酯3mg/kg+喷他佐辛2mg/kg+托烷司琼10mg进行术后镇痛。观察项目有:术后2h、6h、12h、24h、48h患者的视觉模拟评分(visual analogue scale,VAS)、Ramsay镇静评分(RSS)、血压和心率以及患者是否会发生恶心、呕吐、口干、便秘、呼吸抑制等并发症。结果:1.VAS水平:F组患者的VAS评分高于同时间点S组患者,但差异无统计学意义(P0.05)。2.RSS水平:F组患者在T2、T6、T12、T24时RSS评分高于高于S组,但差异无统计学意义(P㧐0.05),T48时,两组患者镇静评分无差异。3.术后镇痛副作用的结果:S组患者中有出现术后恶心呕吐(Postoperative nausea and vomiting,PONV)者9人;出现低血压者2人。F组出现恶心者有2人。4.血流动力学:两组患者各时间点的心率没有统计学差异;在术后T12和T48时F组收缩压显著高于S组,其余各时间点两组血压差异无统计学意义。5.补救治疗:F组患者有一人在术后2h需要注射吗啡加强镇痛,S组中没有患者需要加强镇痛;S组有1名患者给予甲氧氯普胺10mg对恶心、呕吐进行治疗。结论:1.氟比洛芬酯联合喷他佐辛与舒芬太尼联合喷他佐辛相比镇痛效果无显著差异、镇痛满意。2.氟比洛芬酯联合喷他佐辛对患者镇静作用和血流动力学的影响与舒芬太尼联合喷他佐辛相似,但PONV的发生率较舒芬太尼联合喷他佐辛组低。
[Abstract]:Background: at present, more and more patients choose laparoscopic surgery. Laparoscopic hysterectomy is less painful than open hysterectomy. Even so, poor pain control is still an urgent problem. There are many guidelines for postoperative pain control, but none of them are related to laparoscopic hysterectomy. Objective: to investigate the effect of flurbiprofen combined with pentazol on postoperative analgesia and the incidence of adverse reactions and hemodynamics in patients undergoing laparoscopic hysterectomy. Methods: from March 2016 to July 2016, 80 patients were selected for elective laparoscopic hysterectomy in the Department of Gynecology, affiliated Peace Hospital of Changzhi Medical College. Patients in group S and group F were randomly divided into two groups: group S and group F were treated with intravenous controlled analgesia after operation. Patients in group S were treated with sufentanil, 1ug/kg, 2mg/kg, tropisetron, 10 mg / g, group F, flurbiprofen ester, 3mg/kg, and 2mg/kg tropisetron 10mg for postoperative analgesia. The observation items were as follows: visual analogue scalescale, Ramsay sedation score, blood pressure, heart rate and complications such as nausea, vomiting, dry mouth, constipation, respiratory depression and so on were observed at 2 h, 6 h, 12 h, 24 h and 48 h after operation. Results 1. The VAS score of the patients in the VAS group was higher than that in the S group at the same time point, but there was no significant difference between the two groups in the scores of RSS at T2T6 and T12T24, but there was no significant difference in the scores of sedation between the two groups at the time of T2T6 and T12T24, but there was no significant difference in sedation score between the two groups. The results of postoperative analgesic side effects were found in 9 patients with postoperative nausea and vomiting PONVN in group S, 2 patients with hypotension in group F, 2 patients with nausea in group F, and 2 patients with nausea in group F (P < 0.05). Hemodynamics: there was no significant difference in heart rate between the two groups at each time point, systolic blood pressure in group F was significantly higher than that in group S at T12 and T48 after operation, and there was no significant difference in blood pressure between the two groups at other time points. 5. There was no need to strengthen analgesia in group S and 1 patient in group S received metoclopramide 10mg to treat nausea and vomiting. Conclusion 1. There was no significant difference in analgesic effect between flurbiprofen and sufentanil. The sedation and hemodynamic effects of flurbiprofen combined with pentazolin were similar to those of sufentanil, but the incidence of PONV was lower than that of sufentanil combined with tazoxin.
【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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