【作者】 刘宇；

【导师】 潘振祥；

【作者基本信息】 吉林大学 ， 临床医学硕士（麻醉学）（专业学位）， 2022， 硕士

【摘要】 目的:将羟考酮静脉注射联合罗哌卡因局部浸润应用于妇科腹腔镜患者术后镇痛,探讨其对患者术后快速康复的影响。方法:选取吉林大学第二医院2021年1月至2021年12月行妇科腹腔镜手术的患者,随机分为羟考酮静脉注射联合罗哌卡因局部浸润组(RO组)、静脉自控镇痛组(PCIA组)和对照组(C组),每组20例,共60例。三组患者在常规诱导后行气管插管保证通气。RO组患者手术结束前20分钟静脉注射盐酸羟考酮注射液0.1mg/kg,在关闭气腹后用0.375%罗哌卡因做切口局部浸润;PCIA组手术结束后连接患者静脉自控镇痛泵(PCIA内药物:舒芬太尼1.0μg/kg、多拉司琼12.5mg,用0.9%生理盐水稀释到100ml;PCIA参数:负荷剂量2ml/h,自控镇痛剂量1ml,锁定时间20min);C组无处理。记录患者一般情况、手术时间、手术方式、苏醒时间、拔管时间、呛咳反应发生例数和拔管后的Ramsay镇静评分。记录患者拔管后5min(T0)、术后2h(T1),6h(T2)、8h(T3)、10h(T4)、12h(T5)、24 h(T6)和48h(T7)的VAS评分。如果48小时内VAS评分大于3分,给与患者舒芬太尼5μg行镇痛补救并记录使用例数。记录患者术后麻醉满意度评分、首次下床活动时间、排气时间、住院时间、住院费用,以及48小时内不良反应的发生例数。结果:1.三组患者的一般情况和临床资料无统计学差异(P>0.05)。2.三组患者的苏醒时间、拔管时间和拔管后的Ramsay镇静评分无显著差异(P>0.05)。RO组的呛咳反应发生率和T0(拔管后5min)时的VAS评分均低于PCIA组和C组(P<0.05)。3.RO组和PCIA组T1、T2、T3、T4时的VAS评分低于C组,差异有统计学意义(P<0.05)。且C组患者术后48小时内补救镇痛的例数较多(P<0.05)。4.RO组患者术后头晕、恶心呕吐发生例数明显低于PCIA组(P<0.05)。5.RO组的麻醉满意度显著高于PCIA组和C组(P<0.05)。6.RO组的下床时间、排气时间明显早于PCIA组和C组(P<0.05),PCIA组的下床时间早于C组(P<0.05)。PCIA组和C组平均住院时间明显长于RO组(P<0.05)。PCIA组平均住院费用明显高于RO组(P<0.05)。结论:羟考酮静脉注射联合罗哌卡因局部浸润可提高妇科腹腔镜患者术后镇痛效果,促进患者术后康复,为临床提供参考。更多还原

【Abstract】 Objective:To observe the effects of oxycodone intravenous injection combined with local infiltration of ropivacaine on the enhanced recovery after gynecological laparoscopy surgery.Method:60 patients from the Second Hospital of Jilin University who were scheduled to undergo elective gynaecological laparoscopic surgery under general anesthesia from January 2021 to December 2021 were enrolled in the study.The patients were randomly divided into groups RO(ropivacaine+oxycodone),PCIA(PCIA)and C(control),20 cases in each group.Three groups of patients underwent tracheal intubation to ensure ventilation after routine induction.The patients in group RO were intravenously injected with oxycodone 0.05 mg/kg 20 minutes before the end of the surgery,and tinfiltrated locally with 0.375% ropivacaine after closing the pneumoperitoneum.Patients in group PCIA were connected to PCIA after surgery(drug preparation: 1 ug/kg sufentanil was combined with 12.5mg dolasetron.The mixture was produced with 0.9% normal saline in 100 ml,the background infusion rate was 2ml/h,the single press dose was 1ml and the locking time was 15min).Patients in group C was not treated.The general condition,operation time,operation method,awake time,tracheal extubation time,the occurrence of cough and Ramsay score after tracheal extubation were recorded.The postoperative VAS scores was recorded at 5min after tracheal extubation and 2h,6h,8h,10 h,12h,24 h and 48 h after the operation.If the VAS score of the patients was over 4,5 ug sufentanil was used and the number of patients who used sufentanil was recorded.The satisfaction score for anesthesia,time to get out of bed for the first time,exhaust time,hospitalization time,hospitalization expenses,and the occurrence of adverse reactions were recorded.Results:1.There was no statistical difference in the general condition and clinical data among the three groups(P>0.05).2.There was no significant difference in the recovery time,extubation time and Ramsay score among the three groups(P>0.05).Compared with the group RO,the patients in group PCIA and group C had higher incidence of choking reaction and the VAS score at T0(P<0.05).3.Compared with the group C,the group RO and PCIA had lower VAS scores at T1,T2,T3,and T4(P<0.05).There were more cases of rescue analgesia in group C(P<0.05).4.Compared with the group PCIA,the group RO had lower incidence of dizziness,nausea and vomiting(P<0.05).5.Compared with the group RO,the anesthesia satisfaction score of group PCIA and C was significantly decreacesd(P<0.05).6.The time to get out of bed and exhaust time in group RO were significantly earlier than those in group PCIA and group C(P<0.05).The average hospitalization time of group PCIA and group C was significantly longer than that of group RO(P<0.05).The average hospitalization cost of group PCIA was significantly higher than that of group RO(P<0.05).Conclusion:Oxycodone intravenous injection combined with local infiltration of ropivacaine can improve postoperative analgesia in gynecological laparoscopic patients,accelerate postoperative recovery,and provide clinical reference.更多还原