执业医师职称晋升论文赏析(46)

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1、氟比洛芬酯用于静脉镇痛的临床观察作者：郑恒兴张康秦乔英王宵鹏梁斌任应娜作者单位：721008陕西宝鸡市中心医院麻醉手术科科研项目宝鸡市卫生局科研资助项目【摘要】目的：观察氛比洛芬酯术后静脉镇痛的临床效果，最佳方案及不良反应。方法:选择期分別行颈胸部、脊柱、上腹部、下腹部和四肢等四个部位手术患者400例实施术后静脉镇痛，每部位患者100例。每部位手术患者随机分为四组，镇痛泵配制方案I组：芬太尼20»g/kg;II组:芬太尼10Pg/kg+氟比洛芬酯0.8〜1mg/kg;III组：芬太尼10ug/kg+氟比洛芬酯1.6〜2mg/kg;IV组：芬A尼10ug/kg+氟比

2、洛芬酯0.8〜1mg/kg,并于麻醉前静注氟比洛芬酯0.8〜1mg/kg0各组镇痛泵均以0.9%生理盐水稀释到100mlo镇痛期间观察患者48小时内镇痛效果(VAS法)、血流动力学变化及其恶心、呕吐的发生率。结果：四个手术部位患者各组在术后镇痛期I'可血流动力学变化无明显差异;各手术部位患者的术后镇痛效果，笫III、IV组均明显优于第I、II组(PV0.01),且下腹部和四肢部位手术患者的术后镇痛效果，第IV组明显优于第III组(P<0.05);各手术部位患者恶心、呕吐发生率第1【、【II、IV组均明显低于第I组(P<0.05)o结论：①氟比洛芬酯用于静脉术后镇痛

3、可明显增加镇痛效果，降低芬太尼用量，减少患者的恶心、呕吐发生率;②氟比洛芬酯剂量增加可明显增加各部位手术患者的术后镇痛效果;③氟比洛芬酯超前镇痛可以明显增强局部麻醉(椎管内麻醉、神经阻滞等)术后镇痛效果。【关键词】术后镇痛静脉氟比洛芬酯AbstractObjective:Tostudytheeffects,optimalscheduleandadverseeffectsofflurbiprofenaxetilforpostoperativeintravenousanalgesia.Methods:FourhundredpatientsASAI〜IIweredivi

4、dedintooperationonneckandthoraxregion(NT),columnavertobralisregion(CV),upperabdominalregion(UA),and,lowerabdomenandlimbsregion(LL).Eachregionwithonehundredpatients.Allpatientswereadministratedwithpostoperativeintravenousanalgesia.Patientsofeachoperatedregionweredividedrandomlyintofour

5、groups.ThedrugsofanalgesiapumpwereformulatedbygroupIwithfentany120卩g/kg,groupIIwithfentanyl10ug/kg+flurbiprofenaxetil0.8^1mg/kg,groupIIIwithfentanyl10ug/kg+flurbiprofenaxetil1.6〜2mg/kg,groupIVwithfentanyl10Ug/kg+flurbiprofenaxetil0.8〜1mg/kg.AndpatientsingroupIVwerealsoenforcedwithinje

6、ctionofflurbiprofenaxetil0.8~1mg/kgbeforeanesthesia.Theformulateddrugsweredilutedto100mlby0.9%physiologicalsaline.Toobservedanalgesiaeffectiveness(byVASmethod),hemodynamics,andincidenceofnauseaandvomitingofeachpatientsduring48hoursafterpostoperativeintravenousanalgesia.Results:Thehemo

7、dynamicsofeachpatientwerenotsignificantlyvariationduring48hoursanalgesiaperiod.TheanalgesiaeffectsofgroupIIIandIVwereobviouslybetterthanthatofgroupIandIIinalloperationregionpatients(P<0.01),andtheeffectsofgroupIVwerealsoobviouslybetterthanthatofgroupIIIonlyinLLoperationregionpatient(P

8、<0.05