地佐辛+舒芬太尼复合不同剂量右美托咪定在经腹子宫切除术中的应用效果

[目的]探讨地佐辛+舒芬太尼复合不同剂量右美托咪定在经腹子宫切除术中的应用效果.[方法]将160例行经腹子宫切除术患者随机分为4组,每组各40例,A组、B组、C组分别给予地佐辛+舒芬太尼复合0.5 μg/kg、1.0μg/kg、1.5 μg/kg右美托咪定进行自控静脉镇痛,D组予地佐辛+舒芬太尼进行自控静脉镇痛,比较4组术后1 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)疼痛程度(VAS)、舒适程度(BCS)、Ramsay评分及不良反应发生率.[结果]与A、D组比较,B组、C组T2、T3时刻VAS评分明显降低(P＜0.05),T3、T4、T5时刻BCS评分均明显升高(P＜0.05);与C组比较,B组T3、T4时刻Ramsay评分均明显降低(P＜0.05);A组、B组不良反应发生率均低于C组和D组(P＜0.05).[结论]在经腹子宫切除术中,地佐辛+舒芬太尼复合1.0 μg/kg右美托咪定术后镇痛效果较好,不良反应少,且舒适度较高,值得临床重视.     

右美托咪定联合舒芬太尼术后PCIA的镇痛效果

目的：观察右美托咪定联合舒芬太尼用于妇科手术患者术后自控静脉镇痛（PCIA）评价其镇痛效果及安全性,为临床选择用药提供参考。方法选择择期全身麻醉下行妇科子宫次全切手术患者60例,ASAⅠ或Ⅱ级,按随机数字表法分为舒芬太尼组（C组30例）,右美托咪定组（D组）。 C组：舒芬太尼2滋g·kg-1,加生理盐水配制至200 mL术后镇痛泵自控镇痛;D组：右美托咪定200滋g＋舒芬太尼2滋g·kg-1,加生理盐水配制至200 mL镇痛泵自控镇痛。分别于术后4、8、16、24 h对患者进行VAS疼痛评分、Ramsay镇静评分并记录术后24 h内不良反应的对比。结果 D组术后各时间点的VAS评分、术后PCIA自控按压次数、舒芬太尼用量均低于C组,其差异有统计学意义（P＜0.05）;2组术后Ramsay镇静评分差异无统计学意义（P＞0.05）;D组与C组PCIA期间恶心、呕吐、头晕、皮肤瘙痒等发生率差异均无统计学意义（P＞0.05）,2组均未发生低血压、心动过缓以及呼吸抑制等不良反应。结论右美托咪定联合舒芬太尼行术后PCIA可减少舒芬太尼使用剂量,镇痛效果明显优于单纯应用舒芬太尼,可在妇科手术患者术后PCIA中应用。     

右美托咪定复合舒芬太尼在创伤骨科患者术后镇痛中应用

目的 探讨不同剂量右美托咪定复合舒芬太尼用于创伤骨科患者术后镇痛、镇静的效果及安全性.方法 ASAⅠ～Ⅱ级行创伤骨科手术患者60例,随机分为3组各20例.舒芬太尼组术后自控镇痛应用舒芬太尼1.0μg/(kg·d)+阿扎司琼6 mg+生理盐水100 mL,低剂量右美托咪定复合舒芬太尼组(低剂量组)应用右美托咪定1.0μg/(kg·d)+舒芬太尼1.0 μg/(kg·d)+阿扎司琼6 mg+生理盐水100mL,高剂量右美托咪定复合舒芬太尼组(高剂量组)应用右美托咪定1.5 μg/(kg·d)+舒芬太尼1.0 μg/(kg·d)+阿扎司琼6 mg+生理盐水100mL.记录3组术后2 h (T1)、4 h(T2)、8 h(T3)、24 h(T4)、48 h(T5)VAS、Ramsay评分,比较3组术后48 h自控镇痛按压次数及不良反应发生情况.结果 T1、T2、T3、T4、T5时间点,低剂量组VAS评分(1.5±0.8、1.2±0.8、1.1±0.9、1.0±0.9、0.8±0.6),高剂量组VAS评分(1.3±1.0、1.4±0.9、1.2±0.8、1.0±0.8、0.9±0.8)均低于舒芬太尼组(2.3±0.8、2.2±0.9、1.9±0.9、1.8±0.9、1.6±0.9)(P＜0.05),低剂量组Ramsay评分(2.9±0.6、2.7±0.7、2.4±0.7、2.2±0.6、2.2±0.5)、高剂量组Ramsay评分(3.0±0.5、3.0±0.6、2.7±0.6、2.6±0.8、2.4±0.6)均高于舒芬太尼组(1.8±0.5、2.0±0.5、1.9±0.5、1.8±0.5、2.0±0.6)(P＜0.05),低剂量组与高剂量组各时间点VAS评分比较差异无统计学意义(P＞0.05),高剂量组T4时间点Ramsay评分高于低剂量组(P＜0.05);舒芬太尼组术后48 h自控镇痛按压次数((68±3)次)高于低剂量组((25±6)次)和高剂量组((11±2)次)(P＜0.05),恶心呕吐发生率(30.0％)高于低剂量组(10.0％)和高剂量组(5.0％),心动过缓发生率(10.0％)低于低剂量组(30.0％)和高剂量组(30.0％)(P＜0.05),高剂量组自控镇痛按压次数和恶心呕吐发生率低于低剂量组(P＜0.05).结论 右美托咪定复合舒芬太尼用于创伤骨科患者术后镇痛、镇静效果优于舒芬太尼,并可降低恶心呕吐发生率;应用高剂量右美托咪定自控镇痛次数较少,恶心呕吐发生率低,但可导致过度镇静.     

小剂量右美托咪定复合地佐辛在开胸手术术后镇痛中的应用

目的观察小剂量右美托咪定(DEX)复合地佐辛在胸科手术术后镇痛的效果。方法选择ASA I-II级择期行开胸手术患者45例,随机均分为三组,P组术后镇痛给予地佐辛1.0 mg/kg,同时予盐水安慰剂持续泵入;D1组在P组的基础上,给予右美托咪定0.1 g/(kg·h)持续静脉注入;D2组术后镇痛药与D1组相同,只是右美托咪定0.2 g/(kg·h)。地佐辛输注的背景速度为2 ml/h,单次按压追加剂量为1 ml/h,锁定时间15 min。记录患者术后入胸科ICU2 h(T1)、4 h(T2)、6 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)血压、心率、呼吸频率、血氧饱和度、VAS评分、Ramsay评分,以及相关不良反应;同时记录各时间点地佐辛消耗量。结果与P组比较,D1、D2组各时间点VAS评分均明显降低(P0.05),Ramsay评分明显升高(P0.05)。D1与D2组比较,VAS评分无统计学差异(P0.05),而D2组T3、T4时间点Ramsay评分明显高于D1组(P0.05)。与P组比较,D1、D2组T1、T2、T3、T4时间点血压、心率更稳定,各时间点地佐辛消耗量明显减少(P0.05),D2组地佐辛消耗量在T4、T5、T6时间点明显小于D1组(P0.05)。D1、D2组不良反应发生率低于P组(P0.05),D1与D2组不良反应发生率无显著差异。(P0.05)。结论小剂量(0.1~0.2g/(kg·h)右美托咪定可明显减少地佐辛的镇痛用量,可给开胸手术患者提供较好的术后镇痛及镇静,血流动力学稳定,并减少术后不良反应。     

右美托咪定复合舒芬太尼在脊柱内固定手术患者术后镇痛中的效果

目的探讨右美托咪定复合舒芬太尼在脊柱内固定手术患者术后镇痛中的效果。方法对2018年4月至2019年4月我院行脊柱内固定术的50例患者的临床资料进行回顾性分析,按术后镇痛方法分为观察组和对照组各25例。观察组镇痛泵(PCIA)采取右美托咪定+舒芬太尼,对照组PCIA单用舒芬太尼,比较两组患者术后不同时间的镇痛、镇静效果及不良反应发生情况。结果术后各时间点观察组患者视觉模拟疼痛评分(VAS)及Ramsay镇静评分均低于对照组,不良反应发生率均低于对照组(P<0.05).结论脊柱内固定手术患者术后镇痛采用右美托咪定复合舒芬太尼,镇静、镇痛效果良好,且可降低患者术后疼痛评分及术后恶心、呕吐发生率,并不增加术后不良反应[1]。     

右美托咪定复合地佐辛超前镇痛在肛肠科吻合器痔上黏膜环切术中的应用

目的探讨右美托咪定复合地佐辛超前镇痛用于肛肠科吻合器痔上黏膜环切术(PPH)的效果。方法选取60例择期行PPH术的患者,随机分为右美托咪定+地佐辛组(A组)和生理盐水+地佐辛组(B组),所有患者均实施小剂量鞍麻,比较2组鞍麻阻滞平面固定时(T0)、击发吻合器时(T_1)和手术结束时(T_2)收缩压(SBP)、舒张压(DBP)、心率(HR)、Ramsay镇静评分,术后镇痛效果及并发症发生情况。结果 T_1、T_2时,A组的SBP、DBP、HR显著低于B组(P0.05),Ramsay镇静评分显著高于B组(P0.05)。A组术后4、8、12、24、48 h镇痛效果VAS评分均显著低于B组(P0.05)。2组术后肛门坠胀不适感无显著差异(P0.05),2组尿潴留、恶心呕吐、夜间睡眠障碍发生率有显著差异(P0.01)。结论右美托咪定复合地佐辛超前镇痛应用于PPH术的镇痛效果好。     

右美托咪定对环状混合痔手术Ramsay评分及疼痛程度的影响

目的 研究右美托咪定复合地佐辛超前镇痛对环状混合痔手术患者Ramsay评分及疼痛程度的影响。方法 选取行吻合器痔上黏膜环切术治疗的环状混合痔患者94例,按随机数字表法分为观察组和对照组各47例。两组在小剂量鞍麻前10min静脉推注地佐辛5mg,麻醉平面满意后,观察组静脉泵入右美托咪定0.5～0.7μg/(kg·h)直到手术结束,对照组给予等量生理盐水。对比两组鞍麻阻滞平面固定、吻合器击发、手术完成等时间点Ramsay评分及术后1、12、24、48h视觉模拟疼痛评分量表(VAS)评分变化、不良反应发生率。结果 观察组吻合器击发、手术完成时Ramsay评分较对照组高(P0.05);观察组术后1、12、24、48h VAS评分较对照组低(P0.05);观察组不良反应发生率与对照组比较,差异无统计学意义(P0.05)。结论 右美托咪定复合地佐辛超前镇痛应用于环状混合痔手术患者,可改善Ramsay评分,并降低疼痛程度,且具有安全性。     

右美托咪定联合丙泊酚在腹腔镜胆囊切除术患者麻醉中的镇痛和镇静效果

目的 探讨右美托咪定联合丙泊酚在腹腔镜胆囊切除术患者麻醉中的镇痛和镇静效果。方法 回顾性选取2019年6月至2020年11月本院收治的100例腹腔镜胆囊切除术患者,依据麻醉方法将其分为右美托咪定联合丙泊酚、瑞芬太尼组(右美托咪定组)和生理盐水联合丙泊酚、瑞芬太尼组(生理盐水组),各50例。比较两组患者的血流动力学指标、镇痛和镇静效果、术后自主呼吸恢复时间、清醒时间、拔管时间、不良反应发生情况。结果 T₀、T₁、T₂、T₃、T₄时,右美托咪定组的心率、舒张压、收缩压均低于生理盐水组(P<0.05),且右美托咪定组的心率、舒张压、收缩压变化更为平稳。术后2、6、12 h,右美托咪定组的NRS静态、NRS动态评分均低于生理盐水组,Ramsay评分高于生理盐水组(P<0.05)。右美托咪定组的术后自主呼吸恢复时间、清醒时间、拔管时间均短于生理盐水组(P<0.05)。两组的不良反应总发生率无显著差异(P>0.05)。结论 右美托咪定联合丙泊酚应用于腹腔镜胆囊切除术...     

右美托咪定复合地佐辛自控静脉镇痛对老年颈淋巴结结核患者术后认知功能的影响

目的探讨右美托咪定复合地佐辛对颈淋巴结结核手术患者术后认知功能的影响.方法选择某院于2016年4月至2018年3月收治的老年颈淋巴结结核患者126例,随机数表法分为对照组和观察组,各63例.对照组采用丙泊酚复合地佐辛实施自控静脉镇痛,观察组患者采用右美托咪定复合地佐辛实施自控静脉镇痛.采用11点数字评分(NRS)对两组患者术后疼痛进行评估;采用意识错乱评估法(CAM)对患者的术后谵妄(POD)的发生情况进行评估;采用简易智能状态量表(MMSE)对两组患者术后认知功能障碍(POCD)的发生情况进行评价.结果观察组患者活动NRS以及静息NRS评分术后1~24 h同对照组相比,差异无统计学意义(P>0.05);术后1、3 d观察组患者MMSE评分明显高于对照组,差异有统计学意义(P<0.05),而术后5 d以及术后1个月两组患者MMSE评分差异无统计学意义(P>0.05);观察组患者POCD发生率7.9%(5/63),低于对照组POCD发生率17.5%(11/63),差异有统计学意义(χ^2=4.325,P<0.05),观察组和对照组POD发生率比较差异无统计学意义(χ^2=0.981,P>0.05);两组患者术后血清白细胞介素6(IL-6)和肿瘤坏死因子(TNF-α)水平同术前相比显著升高,观察组患者IL-6、TNF-α水平在术后6 h、1 d显著低于对照组,术前以及术后3 d、5 d两组患者的IL-6、TNF-α水平差异无统计学意义(P>0.05).结论对于老年颈淋巴结结核患者,采用右美托咪定复合地佐辛术后镇痛方案能够改善镇痛效果,降低术后应激反应,改善患者的认知功能.     

右美托咪定和瑞芬太尼应用于老年髋部骨折手术术后谵妄的效果对比分析

探索右美托咪定和瑞芬太尼用于老年髋部骨折术后谵妄的效果。以收治的老年髋部骨折患者58例作为研究对象,均接受手术治疗,根据术后镇痛药物的不同分入右美托咪定组(采用右美托咪定镇静)和瑞芬太尼组(采用瑞芬太尼镇静),对比分析两组术后谵妄发生率、Ramsay镇静评分等指标。右美托咪定组术后谵妄发生率(6.67%)低于瑞芬太尼组(35.71%,P0.05);两组术后1h、6h、12h的Ramsay镇静评分相差不大(P0.05);而组内术后6h、12h与术后1h对比,Ramsay镇静评分均有明显降低(P0.05)。对行髋部骨折手术治疗的老年患者术后采用右美托咪定镇痛效果确切,有助于预防术后谵妄的发生,促进患者术后早日康复,值得临床推广应用。     

Postoperative spontaneous breathing with CPAP to normalize late postoperative oxygenation

After intubation for elective upper abdominal surgery 30 patients were randomized in group A or B. Both groups had the same anaesthetics and were ventilated with a tidal volume of 12 ml/kg the rate keeping P_aCO₂ near 40 mm Hg. Group A was ventilated with ZEEP and group B with PEEP 10 cm H₂O. Group A was extubated when VC reached 15 ml/kg and P_aCO₂ did not exceed 50 mm Hg breathing spontaneously. Group B was allowed to breathe spontaneously with CPAP and PEEP 5 cm H₂O (Basel PEEP-Weaner^R) for 3 hours before extubation. Measurements: BP, PAP, RAP, HR, Hb, arterial and mixed-venous blood gases with F_IO₂=0,21. Both groups were similar in age, sex, cigarette consumption, preoperative pulmonary pathology, surgical procedure pathology, surgical procedure and time of operation.Results: RAP, PAP, BP, HR, P_aCO₂, P_aH, P_v–O₂ did not show important differences. Mean P_aO₂ changed as follows: Postoperative chest X-rays showed in Group A a total of 56 negative scores, in Group B 25.Conclusion: After upper abdominal surgery the well known decrease of FRC with its increased venous admixture can be prevented if the patient is ventilated with PEEP during operation and is breathing spontaneously with CPAP and PEEP for 3 postoperative hours before extubation.Deceased 1976     

两种不同止痛方案对二尖瓣置换术术后患者应激状态的影响

目的 探讨芬太尼经静脉自控止痛（PCA）对二尖瓣置换术（MVR）术后患者应激状态的缓解作用。方法 60名MVR患者随机分为2组,CAT组为常规止痛组,术后按需给予吗啡0．10-0.20mg/kg静脉注射;PCA组为术后使用PCA给药装置持续输入芬太尼50μg/ml,持续背景输入速度25μg/h,单次给药剂量25μg,锁定时间15min。术后48h内观察止痛效果,术后24h、术后24h,48h测定血糖水平和尿去甲肾上腺素水平。结果 PCA组术后止痛效果明显好于CAT组,术后24h血糖水平CAT组明显高于PCA组（P＜0．05）,术后24h,24-48h CAT组尿NA水平均明显高于PCA组（P＜0．05）。结论 芬太尼经静脉PCA用于MVR术后患者可以明显缓解术后应激状态,有利于术后康复。     

右美托咪啶预防儿童术后躁动的观察及护理

目的 探讨右美托咪啶预防儿童吸入七氟烷全身麻醉后躁动的疗效及护理.方法 选择60例5～8岁拟行全身麻醉的患儿,随机分为观察组和对照组,每组30例.观察组予手术结束前30min静脉推注右美托咪啶0.2μg/kg.对照组静脉推注生理盐水10 ml.记录苏醒时间、拔除气管导管时间及发生躁动、恶心、呕吐的例数.结果 两组苏醒时间、拔除气管导管时间比较无显著性差异（P＞0.05）.手术后躁动的发生率观察组2例（6.7％）比对照组12例（40.0％）低,有显著性差异（P＜0.05）;结论 右美托咪啶能降低七氟烷吸入全身麻醉患儿术后麻醉恢复期躁动,护理观察重点是保证患儿呼吸道的通畅、预防患儿外伤、坠床和脱管等.     

快速缓解术后口干症的方法

病人在手术过程中。     

The Impact of Preoperative Patient Anxiety on Postoperative Anxiety and Quality of Recovery After Orthopaedic Surgery

PurposeTo study how preoperative anxiety affects postoperative recovery in orthopaedic surgery based on two specific issues: does preoperative anxiety affect postoperative anxiety, pain, and nausea in the postanesthesia care unit (PACU) and does preoperative anxiety affect the quality of recovery.DesignThis was a nonexperimental quantitative observational study.MethodsPatients (N = 37) were included through consecutive selection. Anxiety, pain, and nausea were measured preoperatively, 30 minutes after arrival at PACU and before discharge from PACU. Three days after discharge, participants completed the Quality of Recovery Questionnaire by telephone.FindingsThere was a significant correlation between preoperative anxiety and anxiety in PACU as well as anxiety, sadness, and depression 3 days after discharge from PACU.ConclusionsPatients who experience preoperative anxiety also experience anxiety in PACU. The quality of recovery 3 days after surgery is also affected by preoperative anxiety. Patients experience continued anxiety as well as sadness and depression.     

Intermittent Wound Perfusion for Postoperative Pain Relief Following Upper Abdominal Surgery: A Surgeon's Perspective

Background: Although there are many methods for postoperative pain management, implementation may be limited in some settings due to practical or financial constraints. Simple, inexpensive and easily implemented analgesic methods may improve access to effective pain relief. Methods: Fifty patients undergoing truncal vagotomy and gastrojejunostomy for pyloric stenosis secondary to chronic duodenal ulceration were studied in this prospective randomized trial. Subjects were assigned to receive either wound perfusion with 8 mL of 0.25% bupivacaine every 5 hours through a catheter placed subcutaneously or intravenous pethidine 0.2 mg/kg on demand for postoperative pain relief. Postoperative pain scores at rest were measured by visual analog scale and the opioid requirement at 0–12 hours, at 12–24 hours and at 24–36 hours were compared. Changes in respiratory parameters were also compared between the two groups. Results: Pain scores at 0–12 hours were significantly lower in the wound perfusion group compared with the intravenous pethidine group (5.7 ± 1.3 vs. 4.3 ± 1.2, mean ± SD; P < 0.001). The number of doses of analgesic required in the wound perfusion group was significantly lower compared with the controls during the 36 hours of study (3.5 ± 1.3 vs. 1.4 ± 1.0, P < 0.001). There were no differences in respiratory parameters, vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate between the two groups. The FEV1 : FVC ratio, however, was significantly higher in the intravenous pethidine group. There were no wound complications due to catheter placement or systemic toxicity due to the anesthetic. Conclusion: Intermittent wound perfusion with 0.25% bupivacaine is a safe and efficient method to reduce pain scores and opioid requirement in the early postoperative period. Wound perfusion, however, had no beneficial effect on the postoperative respiratory function.     

The Use of Coffee to Decrease the Incidence of Postoperative Ileus: A Systematic Review and Meta-Analysis

PurposeTo investigate the efficacy of providing coffee to elective abdominal surgery patients, immediately postoperatively, to lessen postoperative ileus.DesignA systematic review with meta-analysis of six randomized controlled trials published since 2012.MethodsMethodological quality was evaluated using the Cochrane guidelines. The Grading of Recommendations, Assessment, Development, and Evaluations assessment tool evaluated the quality of the evidence. Subgroup analyses were completed if the I² statistic demonstrated heterogeneity (greater than 50%).FindingsCoffee was statistically significant in shortening the time between surgery and the first passage of stool (mean difference, −9.38; 95% confidence interval, −17.60 to −1.16; P = .03). Although not statistically significant (P = .20), the overall effect favored shorter hospital stays for those patients receiving coffee.ConclusionsThe current systematic review and meta-analysis suggests that coffee given as early as 2 hours postoperatively decreases time to first bowel movement. In addition, patients tolerated solid food faster and were discharged sooner when given coffee immediately postoperatively.     

术后护理干预在促进胃癌根治术胃肠功能康复中的应用

目的探讨术后护理干预在促进胃癌根治术患者术后胃肠功能康复中的应用效果。方法将本院2015年7月—2016年3月收治的86例胃癌根治术患者随机分为对照组43例和观察组43例。对照组给予常规护理,观察组给予快速康复为指导,并在对照组基础上强化护理干预,比较2组的术后疼痛情况及胃肠功能情况。结果观察组术后疼痛程度轻于对照组,术后当天、术后1、2 d的疼痛呼唤频率均低于对照组,差异有统计学意义(P0.05)。观察组术后胃乏力的发生率低于对照组,进食时间、肛门排气时间、肠鸣音恢复时间、排便时间均短于对照组,差异均有统计学意义(P0.05)。结论加强术后护理干预能够减轻胃癌根治术患者的术后疼痛,促进胃肠功能恢复,值得推广。