本文選題：連續(xù)腰叢神經(jīng)阻滯 + 電流強度　； 參考：《延邊大學》2017年碩士論文

【摘要】：目的分析不同的電流強度行連續(xù)腰叢神經(jīng)阻滯對人工髖關節(jié)置換術后的鎮(zhèn)痛效果。方法選擇全麻下行人工髖關節(jié)置換手術的患者120例(ASA Ⅰ～Ⅲ級),隨機分為四組(n=30):A組舒芬太尼靜脈鎮(zhèn)痛泵組,N組選用神經(jīng)刺激器行連續(xù)腰叢神經(jīng)阻滯,N1組選擇的電流強度為0.1～0.5mA,N2組選擇0.6～1.0m,N3組選擇1.1～2.0mA。四組患者均行靜吸復合全身麻醉行氣管插管。N組患者全麻誘導前行連續(xù)腰叢神經(jīng)阻滯,通過留置導管自控泵入0.2%羅哌卡因,A組患者術后靜脈給予舒芬太尼自控鎮(zhèn)痛,四組患者均維持鎮(zhèn)痛48小時。分別記錄各組患者術后不同時間點靜息VAS疼痛評分(RVAS)和主動活動的VAS疼痛評分(IVAS)、自控鍵按鍵次數(shù)、患者總體滿意度及不良反應。結果N1組與N2組術后RVAS和IVAS評分無統(tǒng)計學差異,N3組RVAS和IVAS評分明顯高于N1組和N2組(p0.05),A組RVAS和IVAS評分明顯高于N1、N2組(p0.05);N1組與N2組自控鍵48h按鍵次數(shù)無統(tǒng)計學差異,N3組自控鍵 48h 按鍵次數(shù)(3.90 ± 0.96)明顯高于 N1 組(1.93 土 0.98)和 N2 組(2.06 ± 0.98)(p0.01);四組患者的總體滿意度較高;N1-N3組惡心、嘔吐、瘙癢、鎮(zhèn)靜過度等不良反應均無明顯統(tǒng)計學差異,不良反應A組明顯多于N1-N3組(p0.05)。結論選用0.6～1.0mA電流強度下行連續(xù)腰叢神經(jīng)阻滯用于人工髖關節(jié)置換術后自控鎮(zhèn)痛可達到滿意效果,且鎮(zhèn)痛效果優(yōu)于靜脈自控鎮(zhèn)痛,減少術后不良反應。
[Abstract]:Objective to analyze the analgesic effect of continuous lumbar plexus block with different electric current intensity after hip arthroplasty. Methods one hundred and twenty patients undergoing artificial hip replacement under general anesthesia were randomly divided into four groups: sufentanil intravenous analgesia pump group (n = 40) and continuous lumbar plexus block group N (n = 1). The flow intensity was 0.1 ~ 0.5mAN _ 2 group and 0.6 ~ 1.0mN _ 3 group was chosen, and the flow intensity was 1.1 ~ 2.0mA. All the patients in the four groups were treated with intravenous inhalation combined with general anesthesia. The patients in group N received continuous lumbar plexus nerve block before induction under general anesthesia. Sufentanil was administered intravenously to patients in group A by self-controlled infusion of 0.2% ropivacaine via indwelling catheter. Analgesia was maintained for 48 hours in all the four groups. The rest VAS pain score and active activity VAS pain score were recorded at different time points after operation, the number of keystrokes, the patients' overall satisfaction and adverse reactions were recorded. Results there was no significant difference in RVAS and IVAS scores between N1 group and N2 group. The scores of RVAS and IVAS in N3 group were significantly higher than those in N1 group and N2 group. The scores of RVAS and IVAS in group N _ 1 and N _ 2 group were significantly higher than those in group N _ 1N _ 2 group and N _ 2 group. The number of keys in 48 hours was 3.90 鹵0.96), which was significantly higher than that in N1 group (1.93 鹵0.98) and N2 group (2.06 鹵0.98) p0.01.The overall satisfaction of the four groups was higher than that of N1-N3 group. There was no significant difference in adverse reactions such as vomiting, pruritus and excessive sedation. The adverse reactions in group A were significantly higher than those in group N1-N3 (P 0.05). Conclusion continuous lumbar plexus block with 0.6~1.0mA electric current intensity can achieve satisfactory analgesia effect after artificial hip arthroplasty, and the analgesic effect is better than that of intravenous analgesia, which can reduce the adverse reaction after operation.
【學位授予單位】：延邊大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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