地佐辛、布托啡诺复合咪达唑仑对剖宫产术中及术后寒战的预防和治疗作用

发布时间：2018-07-10 09:58

本文选题：地佐辛 + 布托啡诺　；参考：《河北北方学院》2017年硕士论文

【摘要】：目的剖宫产率在国内外呈现逐年递增的趋势,由于孕妇特殊的生理原因,因此术中广泛采用椎管内麻醉。寒战是椎管内麻醉常见的并发症之一,发生率高达5%~65%。术中寒战的发作会导致产妇产生疼痛、不适以及机体代谢增加等一系列反应,不利于麻醉医生准确观察产妇的各项生理指标,也不利于外科手术的顺利进行。针对以上面临的困难,临床上已经尝试了多种辅助用药,如氯胺酮、芬太尼等,但是由于效果单一或不良反应严重等原因,都没有取得满意的效果。本研究拟比较地佐辛、布托啡诺复合咪达唑仑对术中及术后寒战的预防和治疗作用,选择针对寒战安全、有效的预防以及治疗方法,建立一套针对寒战的临床应对方案。方法本研究以2015年7月-2016年7月期间在聊城市东昌府区妇幼保健院接受剖宫产的患者为研究对象,根据纳入和排除标准进行一定的筛选,然后通过随机数字表法将患者分为预防组(胎儿娩出即刻经静脉给药)和治疗组(胎儿娩出后出现寒战即经静脉给药),两组患者数量均为100例。预防组随机分为两组,Ⅰ组地佐辛(0.1mg/kg)+咪达唑仑(0.03mg/kg)和Ⅱ组布托啡诺(0.01mg/kg)+咪达唑仑(0.03mg/kg),各50例;治疗组也随机分为两组,即Ⅲ组地佐辛(0.1mg/kg)+咪达唑仑(0.03mg/kg)和IV组布托啡诺(0.01mg/kg)+咪达唑仑(0.03mg/kg),各50例。通过观察比较各时间点(入室—T0、用药前—T1、用药后3min—T2、5min—T3、10min—T4、30min—T5和1h—T6)患者的平均动脉压(MAP)、心率(HR)、呼吸(RR)、寒战分级、寒战治疗疗效、牵拉反应分级、Ramsay镇静评分以及其他不良反应(如恶心呕吐、呼吸抑制、宫缩痛等),获得对于预防以及治疗寒战的优化用药方案。结果(1)预防组和治疗组患者的组内基线资料比较无统计学差异(P0.05)。(2)预防组中Ⅰ组在T4时间点轻微降低了患者MAP(P0.05),预防组其余时间点以及治疗组患者各个时间点组内MAP比较无统计学差异(P0.05)。(3)预防组和治疗组患者组内HR各个时间点比较无统计学差异(P0.05)。(4)在呼吸功能方面,预防组和治疗组患者组内各个时间点比较无统计学差异(P0.05)。(5)预防组患者组内寒战比较无明显差异(P0.05);治疗组患者IV组用药消除寒战时间明显短于Ⅲ组(P0.01),但治疗寒战有效率方面无明显差异(P0.05)。(6)预防组内,Ⅰ组用药治疗牵拉反应明显优于Ⅱ组(P0.05);治疗组中,两组用药对于牵拉反应治疗无明显差异(P0.05)。(7)预防组中Ⅱ组在T3和T5时间点增加了患者Ramsay镇静评分(P0.05),T4时间点明显增加了患者Ramsay镇静评分(P0.01);治疗组中IV组在T2时间点增加了患者Ramsay镇静评分(P0.05)。结论在预防寒战方面,两组联合用药都具有明显疗效,其中地佐辛+咪达唑仑组牵拉反应和嗜睡反应轻于布托啡诺+咪达唑仑;在治疗寒战方面,布托啡诺+咪达唑仑组消除寒战时间明显短于地佐辛+咪达唑仑组。所以,预防寒战推荐的用药方案是地佐辛+咪达唑仑;治疗寒战推荐的用药方案是布托啡诺+咪达唑仑。
[Abstract]:Objective the rate of caesarean section is increasing year by year at home and abroad. Because of the special physiological causes of pregnant women, intraspinal anesthesia is widely used in the operation. Shivering is one of the common complications of intraspinal anesthesia. The incidence of cold war in 5%~65%. can lead to a series of anti pain, discomfort and increase of body metabolism. It is not beneficial for the anesthesiologist to observe all the physiological indexes of the parturient, and it is not conducive to the smooth operation of the surgery. In view of the difficulties faced above, a variety of adjuvant drugs have been tried in clinic, such as ketamine and fentanyl, but the results are not satisfactory because of the single effect or serious adverse reaction. To compare the effect of midazolam and midazolam on the prevention and treatment of intraoperative and postoperative chills, a set of clinical coping strategies aimed at chills, effective prevention and treatment was set up for chills. Methods this study was conducted in the July 2015 -2016 July period in the maternal and child health care hospital in Dongchangfu District, Liaocheng. The patients in the palace were selected and selected according to the inclusion and exclusion criteria. Then the patients were divided into the prevention group (the fetal delivery out of the vein) and the treatment group by the random digital table. The number of the two groups were 100 cases. The prevention group was randomly divided into two groups. Zosin (0.1mg/kg) + midazolam (0.03mg/kg) and group II (0.01mg/kg) + midazolam (0.03mg/kg), each of 50 cases; the treatment group was also randomly divided into two groups, namely, group III Zosin (0.1mg/kg) + midazolam (0.03mg/kg) and IV group Bhutto enphol (0.01mg/kg) + midazolam (0.03mg/kg), each of the 50 cases. The average arterial pressure (MAP), heart rate (HR), respiratory (RR), shivering classification, shivering treatment, traction reaction classification, Ramsay sedation score and other adverse reactions (such as nausea, vomiting, respiratory depression, contraction pain, etc.) were obtained for the prevention and treatment of cold. The average arterial pressure (MAP), heart rate (HR), respiratory (RR), shivering grade, shivering treatment effect, traction reaction classification, Ramsay sedation score and other adverse reactions (such as nausea, vomiting, respiratory depression, contraction pain, etc.) were obtained. Results (1) there was no statistical difference in baseline data between the prevention group and the treatment group (P0.05). (2) the group I in the prevention group decreased the patient MAP (P0.05) slightly at the T4 time point, and the rest time points of the prevention group and the MAP in the treatment group had no statistical difference (P0.05) (3) the prevention group and the prevention group (3) the prevention group and the prevention group. There was no statistical difference in the time points of HR in the treatment group (P0.05). (4) in the respiratory function, there was no significant difference in the time points between the prevention group and the treatment group (P0.05). (5) there was no significant difference (P0.05) in the group of patients in the prevention group (P0.05); in the treatment group, the time of eliminating the chills was significantly shorter in group IV than in group III (P0 .01), but there was no significant difference in the efficiency of the treatment of chills (P0.05). (6) in the prevention group, the traction reaction in group I was obviously better than that in group II (P0.05); in the treatment group, there was no significant difference between the two groups in the treatment of traction reaction (P0.05). (7) the group II group increased the Ramsay sedation score (P0.05) at the time point of T3 and T5 in the prevention group, and the T4 time was clear. The patient's Ramsay sedation score (P0.01) was significantly increased; the group IV in the treatment group increased the patient's Ramsay sedation score (P0.05) at the time point of T2. Conclusion in the prevention of chills, two groups of combined drugs have obvious curative effect. The elimination of chill time in the torphanol + midazolam group was significantly shorter than that of the triazolam + midazolam group. Therefore, the recommended regimen for prevention of chills was triazocine + midazolam, and the recommended regimen for the treatment of chills was Bhutto + midazolam.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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