本文選題：自控-靶控鎮(zhèn)痛 + 靶濃度靶控輸注　； 參考：《廣西醫(yī)科大學》2015年碩士論文

【摘要】：目的探討應用Tivatrainer藥代動力學模擬軟件擬合舒芬太尼自控-靶控輸注技術(PCA-TCI)在腹腔鏡下婦科手術術后鎮(zhèn)痛的有效性和安全性。方法36例ASAI-II級擇期行腹腔鏡下婦科手術的患者,用SPSS軟件隨機分為自控-靶控組(A)和靶控組(B)二組,每組n=18例�；颊咝g中靶控輸注舒芬太尼和異丙酚,應用Tivatainer藥代動力學軟件擬合患者血漿藥物濃度,在血漿靶濃度達到0.1ng/ml (記為T。)開始上鎮(zhèn)痛泵。在上泵時(T0)及上泵后T1(30min)、T2 (1h)、T3 (2h)、T4 (4h)、 T5 (6h)、T6(8h)、T7(16h)各時點,記錄Prince-Henry鎮(zhèn)痛評分、Ramsay鎮(zhèn)靜評分、生命體征及各時間舒芬太尼用藥量和不良反應發(fā)生情況,并在T0、T2、T4、T6行血氣分析,在各個時間點上取得相對應的舒芬太尼血漿靶濃度值。結果(1)兩組患者一般資料基本一致,無統(tǒng)計學差別。(2)兩組各時點MAP、HR、RR、SpO2、鼻測PetC02和血氣值在正常范圍內。(3)兩組患者Prince-Henry鎮(zhèn)痛評分、Ramsay鎮(zhèn)靜評分差異無統(tǒng)計學意義。(4)A組術后16小時各時點舒芬太尼用藥量明顯低于B組,差異有統(tǒng)計學意義。(5)兩組患者上泵后舒芬太尼靶濃度各時點組間比較有統(tǒng)計學差異(P0.05)。A組患者靶濃度低于B組,A組患者的有效濃度為0.07±0.03ng/ml。(6)兩組患者鎮(zhèn)痛過程中均未出現(xiàn)鎮(zhèn)痛不足、呼吸抑制、惡心嘔吐等不良反應。結論在婦科腔鏡手術術后病人鎮(zhèn)痛的研究中,自控-TCI與術后靶控鎮(zhèn)痛效果區(qū)別不大,都能夠達到滿意的臨床鎮(zhèn)痛效果,但自控-TCI術后16h舒芬太尼用藥量明顯減少,能最大限度符合個體化按需給藥原則。
[Abstract]:Objective to investigate the efficacy and safety of Tivatrainer pharmacokinetic simulation software fitting sufentanil self-controlled and target-controlled infusion technique (PCA-TCII) for postoperative analgesia after laparoscopic gynecological surgery. Methods Thirty-six patients with ASAI-II grade undergoing elective laparoscopic gynecologic surgery were randomly divided into two groups (n = 18 in each group). The patients were randomly divided into two groups: automatic control and target control group (A) and target control group (B). Sufentanil and propofol were injected intraoperatively by target-controlled infusion. The plasma concentration of sufentanil and propofol was fitted by Tivatainer pharmacokinetic software. The target concentration of sufentanil and propofol reached 0.1ng/ml (T.) Start on the analgesic pump. At each time point, the Prince-Henry analgesia score, the vital signs, the dosage and adverse reactions of sufentanil at each time point were recorded, and the blood gas analysis was performed at T0 / T2T4T6. The corresponding plasma target concentrations of sufentanil were obtained at each time point. Results 1) the general data of the two groups were basically the same. There was no significant difference in Prince-Henry analgesia score and Ramsay sedation score between two groups. The dosage of sufentanil at 16 hours after operation in group A was significantly lower than that in group B. There was significant difference between the two groups in the target concentration of sufentanil after the pump. There was statistical difference in the target concentration of sufentanil between the two groups. The target concentration of group A was lower than the effective concentration of group B (0.07 鹵0.03ng / ml. Respiratory inhibition, nausea, vomiting and other adverse reactions. Conclusion in the study of postoperative analgesia of patients undergoing gynecological endoscopic surgery, the effect of patient-controlled TCI and postoperative target-controlled analgesia is not different, both of them can achieve satisfactory clinical analgesic effect, but the dosage of sufentanil at 16 hours after self-controlled TCI is obviously reduced. It can accord with the principle of individualized medicine on demand to the maximum extent.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R614

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