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1、噴他佐辛超前鎮(zhèn)痛在吻合器痔上粘膜環(huán)切術(shù)中的應(yīng)用湯國(guó)輝伍洲頌劉麗兵鄧秋林邢佼濤南華大學(xué)附屬南華醫(yī)院肛腸外科(湖南衡陽(yáng)421002)摘要目的:探討噴他佐辛超前鎮(zhèn)痛對(duì)吻合器痔上粘膜環(huán)切術(shù)(PPH)鎮(zhèn)痛效果的影響。方法:將100例行PPH的混合痔患者隨機(jī)分為二組,治療組術(shù)前10分鐘予以噴他佐辛30mg肌注,對(duì)照組術(shù)前10分鐘予以安慰劑生理鹽水2ml肌注,二組患者均采用腰俞穴麻醉,評(píng)定術(shù)中牽拉反應(yīng)的抑制效果,觀察二組患者術(shù)后2、6、8h時(shí)VAS評(píng)分及不良反應(yīng)的情況。結(jié)果:治療組術(shù)中牽拉反應(yīng)明顯低于對(duì)照組(P<0.05),
2、治療組各時(shí)點(diǎn)的VAS評(píng)分均低于對(duì)照組(P<0.05),不良反應(yīng)如惡心嘔吐、頭暈兩組比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。結(jié)論:噴他佐辛超前鎮(zhèn)痛用于混合痔PPH手術(shù),能安全有效抑制牽拉反應(yīng),鎮(zhèn)痛效果確切,不良反應(yīng)小,值得臨床進(jìn)一步推廣。關(guān)鍵詞:噴他佐辛;超前鎮(zhèn)痛;PPH術(shù)ApplicationofpentazocinePreemptiveanalgesiainPPHTANGGuo-hui,Zhou-SongWu,Li-BingLiu,Qiu-linDENG,Jiao-TaoXing,ColorectalSurge
3、ry,theAffiliatedNanhuaHospitaloftheNanhuaUniversity,Hengyang,,HunanProvince,China,421002[Abstract]Objective:ToexploretheanalgesiceffectofApplicationofpentazocinewithYaoshuacupointsanesthesiainPPH.Methods:100patientsperformedPPHwererandomlydividedintoexperime
4、ntalgroupandcontrolgroup,with50patientsineachgroup.About10minutesbeforetheoperation,Pentazocine30mgImintheexperimentalgroup.thenaline2mlIminthecontrolgroup.ThetwogroupsoftheanaesthesiaareYaoyuacupoints.BeforeandafterPPHwereobserved,andthepain,forcereflection
5、andadversereactionsoftwogroupswerealsoobserved.TheVASscoresinthe2,6and8hoursafterPPHwerealsoobserved.Results:TheVASscoresofexperimentalgroupduringthethreetimeswaslighterthanthatofcontrolgroupandtheeffectiverateofinhibitingforcereflectionwashigherthanthatofco
6、ntrolgroup.Theadversereactionratewasnobetterthanthatofcontrolgroup.Conclusion:PentazocinewithYaoyuacupointsanesthesiainPPHissafeandeffective,theforcereflectionisslightandbetterthansingleYaoyu.PentazocinewithYaoyuacupointsanesthesiainPPH,thusitisworthyofappli
7、cationinclinic.[Keywords]Pentazocine;Preemptiveanalgesia;Procedureforprolapseandhemorrhoids噴他佐辛(pentazocine,PTZ)是一種新的阿片受體激動(dòng)-拮抗藥物,選擇性地激動(dòng)κ受體,具有良好的鎮(zhèn)痛效應(yīng),且不良反應(yīng)比嗎啡少,已廣泛用于術(shù)后鎮(zhèn)痛,但其在圍術(shù)期超前鎮(zhèn)痛的應(yīng)用鮮見報(bào)道。吻合器痔上黏膜環(huán)切釘合術(shù)(PPH)是一種利用吻合器環(huán)形切除治療Ⅲ、Ⅳ期內(nèi)痔為主的混合痔或環(huán)形內(nèi)痔的重要方法因其手術(shù)時(shí)間短創(chuàng)傷小而廣受歡迎,本文
8、觀察噴他佐辛超前鎮(zhèn)痛對(duì)PPH患者術(shù)中牽拉反應(yīng)的抑制效果和術(shù)后鎮(zhèn)痛效果的影響,以期指導(dǎo)臨床。1、材料和方法1.1材料按隨機(jī)兼顧均衡的原則,將2013-09/2014-01住院的混合痔行PPH手術(shù)的患者,符合納入標(biāo)準(zhǔn)者簽署知情同意書后,分為治療組(噴他佐辛組)和對(duì)照組(生理鹽水組)。共納入100例,試驗(yàn)組50例,對(duì)照組50例。兩組治療前比較及總體統(tǒng)計(jì)比較顯示在性別、年齡、病程和病情等方面差