视网膜脱离患者生存质量及经皮穴位电刺激辅助手术镇痛的临床研究

发布时间：2018-04-28 19:15

本文选题：视网膜脱离 + 手术　；参考：《成都中医药大学》2010年博士论文

【摘要】：目的：(1)研究孔源性视网膜脱离(RRD)患者在手术前后视功能相关生存质量(VRQoL)改变及其影响因素。(2)研究经皮穴位电刺激(TEAS)辅助RRD手术镇痛作用及相关机理,以期发挥中医治疗特色,为临床RRD手术优选镇痛方法,减轻患者手术痛苦,提高生存质量。方法：(1)采用视功能损害患者生存质量量表(AQoL-DVI)),测量92例RRD手术患者手术前和随访期末的VRQoL,并用多元回归方法分析其影响因素。(2)将40例RRD并行巩膜扣带术(SB)患者随机分为局部麻醉组和复合麻醉组(简称复麻组和局麻组),两组均用2%利多卡因和0.894%罗哌卡因各3ml行球后及眼轮匝肌麻醉,复麻组术中辅以Hans神经穴位仪在术侧合谷和内关行经皮穴位电刺激(TEAS)。术中行心电监护,术毕填写简式的McGill疼痛问卷表(Short-form of McGill Pain Questionnaire, SF-MPQ),进行疼痛度VAS评分,术前及术毕抽取2ml静脉血,用酶联免疫吸附法检测血浆β-内啡肽和胆囊收缩素八肽(CCK-8)含量,运用SPSS13.0统计软件对结果进行分析。结果：(1)手术前AQoL-DVI得分最低的条目均在“社会活动能力”方面。手术后量表得分明显提高。手术引起条目得分改变最大的均在“社会活动能力”。影响手术前AQoL-DVI量表得分和手术引起的得分改变的首要独立因素分别是患眼手术前视力和患眼视力改变。(2)复麻组患者手术疼痛强度的VAS评分低于局麻组(P0.05)；情感项和感觉项总分均低于局麻组,差异有统计学意义(P0.05)。术中麻药用量低于局麻组,差异有统计学意义(P0.05)。术中复麻组心率波动低于局麻组,差异有统计学意义(P0.05)。眼心反射阳性率低于局麻组。手术前后血浆β-EP含量比较,两组间差异均无统计学意义(P0.05),局麻组手术前后血浆β-EP含量比较,差异无统计学意义(P0.05),复麻组手术后血浆β-EP含量较术前增加,差异有统计学意义(P0.05)。局麻组与复麻组组内CCK-8浓度术后都比术前增加,差异有统计学意义(P0.05)。但两组间比较,术前术后浓度差异均无统计学意义(P0.05)。结论：(1)AQoL-DVI量表可以敏感反映RRD手术患者VRQoL状况。术前患者因RRD对生活满意程度急剧下降。手术后VRQoL,特别是社会活动能力方面,明显提高。但在完成一些精细工作和日常家务活动时仍有困难。通过提高视力、及时手术和避免手术并发症,有利于RRD患者VRQoL的改善。(2)TEAS辅助局麻对SB具有较好的镇痛作用,优于单纯局麻治疗,可减少术中麻药用量,减少眼心反射发生率,机理可能是通过TEAS联合局麻促进手术疼痛患者体内β-EP的释放,达到镇痛目的。在手术应激状态下,机体释放CCK-8增加。但由于个体差异较大,样本量较小,TEAS对CCK-8释放的影响规律未能观察到。有待今后进一步探索。
[Abstract]:Objective: to study the changes of visual function related quality of life and its influencing factors in patients with rhegmatogenous retinal detachment (RRD) before and after operation. To select the best analgesic method for clinical RRD operation, alleviate the patient's operation pain and improve the quality of life. Methods: using the quality of Life scale (QOL) in patients with visual impairment, 92 patients with RRD were measured before and at the end of follow-up. The influencing factors were analyzed by multivariate regression method. 40 patients with RRD underwent scleral buckling surgery were randomized. Two groups were divided into two groups: local anesthesia group and local anesthesia group. Both groups were treated with 2% lidocaine and 0.894% ropivacaine respectively for backball and orbicularis oculi anesthesia. In the reanesthesia group, Hans nerve acupoint apparatus was used in the operation of Hegu and Neiguan. Electrocardiogram monitoring was performed during the operation. Short-form of McGill Pain Questionnaire, SF-MPQs were filled out at the end of the operation, and the VAS scores of pain degree were evaluated. Blood samples of 2ml were collected before and after operation. Plasma 尾 -endorphin and cholecystokinin octapeptide (CCK-8) were measured by enzyme-linked immunosorbent assay (Elisa). The results were analyzed by SPSS13.0 software. Results (1) the lowest AQoL-DVI scores before surgery were in social activity. After operation, the score of the scale was improved obviously. The most significant change in the score of items caused by surgery was in social activity. The primary independent factors influencing the score of AQoL-DVI scale before operation and the change of score caused by operation were the visual acuity before operation and the change of visual acuity of affected eyes respectively. The VAS score of postoperative pain intensity in patients with reanesthesia group was lower than that in local anesthesia group (P 0.05), affective items and visual acuity of patients with reanesthesia group were lower than those of local anesthesia group (P < 0.05). The total scores of sensory items were lower than those of local anesthesia group. The difference was statistically significant (P 0.05). The dosage of anesthetic during operation was lower than that in local anesthesia group, and the difference was statistically significant (P 0.05). The heart rate fluctuation was lower in the reanesthesia group than that in the local anesthesia group, and the difference was statistically significant (P 0.05). The positive rate of eye and heart reflex was lower than that of local anesthesia group. There was no significant difference between the two groups in plasma 尾 -EP levels before and after operation, but there was no significant difference in plasma 尾 -EP levels before and after operation in the local anesthesia group (P 0.05). The plasma 尾 -EP level in the reanesthesia group was higher than that in the preoperation group, and the difference was statistically significant (P 0.05). The concentration of CCK-8 in local anesthesia group and reanesthesia group was significantly higher than that before operation (P 0.05). However, there was no significant difference in concentration between the two groups before and after operation (P 0.05). Conclusion the AQoL-DVI scale can reflect the VRQoL status of RRD patients. The degree of life satisfaction of patients with RRD decreased dramatically before operation. After operation, VROL, especially the ability of social activities, was significantly improved. But it is still difficult to do some fine work and routine housework. By improving visual acuity, timely operation and avoiding operative complications, it is beneficial to the improvement of VRQoL in patients with RRD. Teas has a better analgesic effect on SB, which is superior to local anesthesia alone, and can reduce the dosage of anesthetic during operation and the incidence of eye and heart reflex. The mechanism may be that TEAS combined with local anesthesia can promote the release of 尾-EP in patients with postoperative pain. Under the condition of surgical stress, the release of CCK-8 was increased. However, due to the large individual differences, the effect of tea on the release of CCK-8 was not observed. Further exploration is needed in the future.
【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2010
【分类号】：R774.1

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