舒芬太尼皮下自控镇痛用于人工关节置换术的临床观察
发布时间：2019-03-05 13:43
【摘要】：目的:1.评价皮下自控镇痛和静脉自控镇痛两种不同镇痛途径在人工关节置换手术患者中应用时的术后镇痛效果;2.评价不同剂量舒芬太尼皮下自控镇痛用于人工关节置换术后的镇痛效果。方法:120例行人工关节置换术患者随机分为六组,其中皮下自控镇痛(Patient-controlled Subcutaneous Analgesia,PCSA)组:S1组(舒芬太尼3.0μg/kg)20例,S2组(舒芬太尼3.5μg/kg)20例,S3组(舒芬太尼4.0μg/kg)20例,静脉自控镇痛(Patient-controlled Intravenous Analgesia,PCIA)组:I1组(舒芬太尼3.0μg/kg)20例,I2组(舒芬太尼3.5μg/kg)20例,I3组(舒芬太尼4.0μg/kg)20例。分别皮下和静脉连接病人自控镇痛(Patient Controlled Analgesia,PCA)泵。PCA泵设置:镇痛液为舒芬太尼3.0~4.0μg/kg+生理盐水至100ml,术后镇痛维持48小时,自控时间锁定15min,自控药液0.5ml/次。观察并记录术后4h、8h、12h、24h、36h及48h六个时间段的疼痛、恶心、呕吐和皮肤瘙痒等情况。结果:1、镇痛评分(1)组间比较:与S1组比较,S2组、S3组各时间的镇痛评分较低,与I1组比较,I2组、I3组各时间的镇痛评分较低,差异有统计学意义(P0.05);S3组、I3组在术后4h、8h的镇痛评分较S2组、I2组低,差异有统计学意义(P0.05)。(2)组内比较:与术后4h比较,I3组、S3组术后8h镇痛评分较高,与术后12h比较,S1组、I1组术后24h镇痛评分较低,与术后24h比较,I1组术后36h镇痛评分较低,差异均有统计学意义(P0.05)。2、镇静评分(1)组间比较:与S1组比较,S2组、S3组在术后4h、8h、12h的镇静评分较高,与I1组比较,I2组、I3组在术后4h、8h、12h的镇静评分较高,差异有统计学意义(P0.05)。(2)组内比较:与术后24h比较,I1组在术后36h镇静评分较高,与术后36h比较,在术后48h镇静评分高,差异有统计学意义(P0.05);其余各组与前一时间比较,差异无统计学意义(P0.05)。3、不良反应:(1)恶心情况:与S3组比较,S1组、S2组恶心发生人数较多,差异具有统计学意义(P0.05)。(2)呕吐情况:与S3组比较,S1组、I3组呕吐发生人数较多,差异具有统计学意义(P0.05)。(3)皮肤瘙痒情况:S组和I组各组组间比较,差异均无统计学意义(P0.05)。结论:老年人工关节置换术后4.0μg/kg的舒芬太尼用于皮下自控镇痛,可以达到较满意的镇痛效果。
[Abstract]:Purpose: 1. To evaluate the analgesic effect of patient-controlled subcutaneous analgesia (PCEA) and patient-controlled intravenous analgesia (PCI) in patients undergoing arthroplasty. To evaluate the analgesic effect of different doses of sufentanil on patients after arthroplasty. Methods: one hundred and twenty patients undergoing artificial joint replacement were randomly divided into six groups: group S _ 1 (sufentanil 3.0 渭 g / kg), group S _ 2 (3.5 渭 g / kg), group S _ 1 (Patient-controlled Subcutaneous Analgesia,PCSA), 20 patients with sufentanil (3.0 渭 g / kg) and group S _ 2 (3.5 渭 g / kg). Group S3 (sufentanil 4.0 渭 g / kg), patient-controlled intravenous analgesia (Patient-controlled Intravenous Analgesia,PCIA) group: group I (3.0 渭 g / kg), group I (3.5 渭 g / kg). Group I (sufentanil 4.0 渭 g / kg) included 20 patients. (Patient Controlled Analgesia,PCA pump: sufentanil 3.0 ~ 4.0 渭 g / kg saline to 100 ml, postoperative analgesia maintained for 48 hours, self-control time locked for 15 minutes. Automatic control liquid 0.5ml/ times. The pain, nausea, vomiting and pruritus were observed and recorded at 4 h, 8 h, 12 h, 24 h, 36 h and 48 h after operation. Results: 1Analgesia score (1): compared with S1 group, S2 group and S3 group, the analgesic score of S2 group and S3 group was lower than that of I1 group, I2 group and I3 group at each time, and the difference was statistically significant (P0.05). The analgesic scores of S1 group, S2 group and S3 group were lower than those of I1 group, I2 group and I3 group (P0.05). The analgesic scores of S3 group and I3 group were lower than those of S2 group and I2 group at 4 h and 8 h after operation (P0.05). (2): compared with postoperative 4h, S3 group had higher analgesia score at 8h after operation, and compared with 12h after operation, the analgesic scores of S3 group were significantly higher than those of S2 group and I2 group (P0.05). The scores of postoperative analgesia in S1 group and I1 group were lower than those in S1 group and I1 group at 24 h after operation, the difference was statistically significant (P0.05). 2, sedation score (1): compared with S1 group, S2 group, S2group, compared with S1 group and S2 group, there was no significant difference between S1 group and I1 group (P0.05). The sedation score of S3 group was higher than that of I1 group, I2 group, I3 group at 4 h, 8 h, 12 h after operation, the difference was statistically significant (P0.05). (2) group: compared with I1 group, I2 group, I3 group had higher sedation score at 4 h, 8 h and 12 h after operation, the difference was statistically significant (P 0.05). The sedation score of I1 group was higher at 36 hours after operation than that at 36 hours after operation, and the difference was statistically significant at 48 hours after operation (P0.05). There was no significant difference between the other groups and the previous time (P0.05). 3. Adverse reactions: (1) nausea: compared with S3 group, S1 group, S2 group had more nausea than S3 group, S1 group and S2 group, the incidence of nausea was higher than that of S3 group, S1 group and S2 group. The difference was statistically significant (P0.05). (2): compared with S3 group, the incidence of vomiting in S1 and I3 groups was higher than that in S3 group. The difference was statistically significant (P0.05). (3) skin itching: there was no significant difference between S group and I group (P0.05). Conclusion: sufentanil (4.0 渭 g / kg) can be used for patient-controlled subcutaneous analgesia in elderly patients after arthroplasty.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
本文编号：2434964
[Abstract]:Purpose: 1. To evaluate the analgesic effect of patient-controlled subcutaneous analgesia (PCEA) and patient-controlled intravenous analgesia (PCI) in patients undergoing arthroplasty. To evaluate the analgesic effect of different doses of sufentanil on patients after arthroplasty. Methods: one hundred and twenty patients undergoing artificial joint replacement were randomly divided into six groups: group S _ 1 (sufentanil 3.0 渭 g / kg), group S _ 2 (3.5 渭 g / kg), group S _ 1 (Patient-controlled Subcutaneous Analgesia,PCSA), 20 patients with sufentanil (3.0 渭 g / kg) and group S _ 2 (3.5 渭 g / kg). Group S3 (sufentanil 4.0 渭 g / kg), patient-controlled intravenous analgesia (Patient-controlled Intravenous Analgesia,PCIA) group: group I (3.0 渭 g / kg), group I (3.5 渭 g / kg). Group I (sufentanil 4.0 渭 g / kg) included 20 patients. (Patient Controlled Analgesia,PCA pump: sufentanil 3.0 ~ 4.0 渭 g / kg saline to 100 ml, postoperative analgesia maintained for 48 hours, self-control time locked for 15 minutes. Automatic control liquid 0.5ml/ times. The pain, nausea, vomiting and pruritus were observed and recorded at 4 h, 8 h, 12 h, 24 h, 36 h and 48 h after operation. Results: 1Analgesia score (1): compared with S1 group, S2 group and S3 group, the analgesic score of S2 group and S3 group was lower than that of I1 group, I2 group and I3 group at each time, and the difference was statistically significant (P0.05). The analgesic scores of S1 group, S2 group and S3 group were lower than those of I1 group, I2 group and I3 group (P0.05). The analgesic scores of S3 group and I3 group were lower than those of S2 group and I2 group at 4 h and 8 h after operation (P0.05). (2): compared with postoperative 4h, S3 group had higher analgesia score at 8h after operation, and compared with 12h after operation, the analgesic scores of S3 group were significantly higher than those of S2 group and I2 group (P0.05). The scores of postoperative analgesia in S1 group and I1 group were lower than those in S1 group and I1 group at 24 h after operation, the difference was statistically significant (P0.05). 2, sedation score (1): compared with S1 group, S2 group, S2group, compared with S1 group and S2 group, there was no significant difference between S1 group and I1 group (P0.05). The sedation score of S3 group was higher than that of I1 group, I2 group, I3 group at 4 h, 8 h, 12 h after operation, the difference was statistically significant (P0.05). (2) group: compared with I1 group, I2 group, I3 group had higher sedation score at 4 h, 8 h and 12 h after operation, the difference was statistically significant (P 0.05). The sedation score of I1 group was higher at 36 hours after operation than that at 36 hours after operation, and the difference was statistically significant at 48 hours after operation (P0.05). There was no significant difference between the other groups and the previous time (P0.05). 3. Adverse reactions: (1) nausea: compared with S3 group, S1 group, S2 group had more nausea than S3 group, S1 group and S2 group, the incidence of nausea was higher than that of S3 group, S1 group and S2 group. The difference was statistically significant (P0.05). (2): compared with S3 group, the incidence of vomiting in S1 and I3 groups was higher than that in S3 group. The difference was statistically significant (P0.05). (3) skin itching: there was no significant difference between S group and I group (P0.05). Conclusion: sufentanil (4.0 渭 g / kg) can be used for patient-controlled subcutaneous analgesia in elderly patients after arthroplasty.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
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