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        氟比洛芬酯聯(lián)合地佐辛對(duì)心臟搭橋術(shù)后患者鎮(zhèn)痛臨床效果研究

        2014-06-26 01:55:13張保軍韓威利
        關(guān)鍵詞:芬酯搭橋術(shù)比洛

        張保軍 韓威利

        【摘要】 目的:分析氟比洛芬酯聯(lián)合地佐辛對(duì)心臟搭橋術(shù)后患者鎮(zhèn)痛效果。方法:選取擇期行心臟搭橋術(shù)患者96例,隨機(jī)分成聯(lián)合組和對(duì)照組,兩組患者麻醉誘導(dǎo)和麻醉維持方法相同,聯(lián)合組:分別于術(shù)前30 min和術(shù)畢前30 min各靜脈滴注氟比洛芬酯50 mg,術(shù)畢前25 min,地佐辛0.8 mg/kg加入0.9%NaCl溶液稀釋至100 mL靜脈泵注;對(duì)照組:分別于術(shù)前30 min和術(shù)畢前30 min各靜脈滴注舒芬太尼3 μg,術(shù)畢前25 min,芬太尼20 μg/kg加入0.9%NaCl溶液稀釋至100 mL靜脈泵注。采用視覺(jué)模擬評(píng)分法和Ramsy鎮(zhèn)靜評(píng)級(jí)法分別對(duì)兩組患者術(shù)后鎮(zhèn)痛和鎮(zhèn)靜效果進(jìn)行評(píng)估,記錄兩組患者不良反應(yīng)情況。結(jié)果:聯(lián)合組患者術(shù)后不同時(shí)點(diǎn)疼痛評(píng)分均低于對(duì)照組,差異均具有統(tǒng)計(jì)學(xué)意義(P<0.05);聯(lián)合組患者術(shù)后不同時(shí)點(diǎn)鎮(zhèn)靜評(píng)級(jí)與對(duì)照組比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05);聯(lián)合組患者總不良反應(yīng)發(fā)生率為12.5%,顯著低于對(duì)照組的52.1%,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論:氟比洛芬酯聯(lián)合地佐辛用于心臟搭橋術(shù)后鎮(zhèn)痛具有較好的鎮(zhèn)痛和鎮(zhèn)靜效果,能夠顯著降低單一用藥時(shí)不良反應(yīng)的發(fā)生,值得臨床進(jìn)一步推廣使用。

        【關(guān)鍵詞】 心臟搭橋術(shù); 氟比洛芬酯; 地佐辛; 芬太尼; 鎮(zhèn)痛

        【Abstract】 Objective:To investigate the analgesic effect of flurbiprofen combined with dezocine in cardiac bypass surgery.Method:96 cases of patients elective for heart bypass surgery were randomly divided into combined group and control group. Anesthesia induction and maintenance of anesthesia on patients in two groups were in the same way. In combined group,30 min before the surgery and 30 min before end of the surgery, 50 mg flurbiprofen was intravenous infusion, respectively.25 min before end of the surgery, dezocine 0.8 mg/kg added 0.9% NaCl solution diluted to 100 mL was intravenous infusion. In control group, 30 min before the surgery and 30 min before end of the surgery, 3 μg sufentanil was intravenous infusion, respectively. 25 min before end of the surgery, fentanyl 20 μg/kg added 0.9% NaCl solution diluted to 100 mL was intravenous infusion.The postoperative effects of analgesia and sedation were evaluated by using visual analog scale and Ramsy sedation rating method, respectively. And the adverse reactions were recorded in the two groups. Result:The pain scores at different time points of patients in combined group were lower than the control group, the differences were all statistically significant (P<0.05). The differences of sedation ratings at different time points between combined group and control group were not statistically significant (P>0.05). The total adverse reaction rate of combined group was 12.5%, which was significantly lower than 52.1% of control group, the difference was statistically significant (P<0.05). Conclusion:In cardiac bypass surgery, flurbiprofen combined with dezocine has better effects of analgesic and sedative. It can significantly reduce the incidence rate of adverse reactions, which occurred when used a single drug. It is worthy of clinical use.

        【Key words】 Heart bypass surgery; Flurbiprofen; Dezocine; Fentanyl; Analgesic

        近年來(lái),隨著生活方式的轉(zhuǎn)變和社會(huì)壓力的日益增大,冠心病的發(fā)病率和現(xiàn)患率呈現(xiàn)逐漸上升趨勢(shì),并日趨年輕化、低齡化,給人們健康和生活質(zhì)量造成嚴(yán)重影響[1-2]。目前,對(duì)于冠心病的治療最有效的方式是進(jìn)行心臟搭橋術(shù),其臨床效果已被證實(shí),并被越來(lái)越多的患者所接受[3]。但是心臟搭橋術(shù)作為一種創(chuàng)傷性較大的手術(shù),一般需要開(kāi)胸操作,切口往往較長(zhǎng),致使患者術(shù)后劇烈疼痛,因此,該手術(shù)的開(kāi)展對(duì)麻醉過(guò)程和術(shù)后鎮(zhèn)痛均要求較高[4]。臨床上常用的術(shù)后鎮(zhèn)痛方式為自控靜脈鎮(zhèn)痛,以往常采用單一鎮(zhèn)痛藥物進(jìn)行鎮(zhèn)痛,但存在效果不佳、不良反應(yīng)較多等不足[5],因此,如何有效避免單一用藥的不良反應(yīng),已成為臨床鎮(zhèn)痛研究重點(diǎn)。本研究通過(guò)探討氟比洛芬酯聯(lián)合地佐辛用于心臟搭橋術(shù)后患者鎮(zhèn)痛臨床效果,以期為臨床應(yīng)用提供基礎(chǔ)資料。endprint

        1 資料與方法

        1.1 一般資料 選取2010年11月-2012年12月在本院心外科擇期行心臟搭橋術(shù)患者96例,ASA評(píng)分Ⅰ~Ⅲ級(jí),其中,男56例,女40例,平均年齡(54.2±8.1)歲,平均體重(54.8±10.5)kg,心功能2~3級(jí)。穩(wěn)定性心絞痛30例,不穩(wěn)定性心絞痛66例。對(duì)所有患者進(jìn)行冠脈造影以確定冠脈病變支數(shù):兩支冠脈病變72例,三支及以上病變24例,冠脈狹窄度>85%。病例排除標(biāo)準(zhǔn):排除呼吸梗阻患者、重要臟器嚴(yán)重功能不全者,以及出現(xiàn)消化道不良反應(yīng)者。對(duì)所有患者按照入院順序進(jìn)行編號(hào),并利用隨機(jī)數(shù)字表進(jìn)行隨機(jī)化分組,分成聯(lián)合組和對(duì)照組,每組48例,其中,聯(lián)合組男29例,女19例,平均年齡(53.8±9.2)歲,對(duì)照組男27例,女21例,平均年齡(54.9±7.9)歲,兩組患者性別、平均年齡、病情、合并癥等一般情況比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。本研究通過(guò)倫理委員會(huì)批準(zhǔn),術(shù)前對(duì)患者均進(jìn)行知情同意。

        1.2 方法 所有患者術(shù)前禁食禁飲8 h,術(shù)前30 min肌內(nèi)注射阿托品0.01 mg/kg和地西泮0.05 mg/kg,并口服β-受體阻滯劑和鈣拮抗劑,以控制術(shù)中患者心率。入室后監(jiān)控患者血壓、心率、血氧飽和度和心電圖等,并打開(kāi)患者靜脈通道。麻醉誘導(dǎo):舒芬太尼0.4 μg/kg+依托咪酯0.3 mg/kg+咪達(dá)唑侖0.1 mg/kg+順苯磺阿曲庫(kù)銨0.2 mg/kg靜注后,進(jìn)行氣管插管并連接麻醉機(jī)。麻醉維持:瑞芬太尼0.1~0.2 μg/(kg·min)+異丙酚3.5~5.0 mg/(kg·h)進(jìn)行持續(xù)靜脈輸注,并根據(jù)肌松情況間斷靜注順苯磺阿曲庫(kù)銨0.2 mg/kg。聯(lián)合組:分別于術(shù)前30 min和術(shù)畢前30 min各靜脈滴注氟比洛芬酯50 mg,PICA方案為靜脈泵于術(shù)畢前25 min連接,地佐辛0.8 mg/kg加入0.9%NaCl溶液稀釋至100 mL;對(duì)照組:分別于術(shù)前30 min和術(shù)畢前30 min各靜脈滴注舒芬太尼3 μg,PICA方案為靜脈泵于術(shù)畢前25 min連接,芬太尼20 μg/kg加入0.9%NaCl溶液稀釋至100 mL。兩組患者均泵注48 h,速率為2 mL/h,進(jìn)行持續(xù)輸注,沖擊量1.0 mL,鎖定15 min。術(shù)畢前靜滴托烷司瓊2 mg,術(shù)畢停用舒芬太尼和異丙酚,同時(shí)常規(guī)給予新阿合劑2個(gè)劑量,將患者喚醒,待患者呼吸平穩(wěn)后,將氣管導(dǎo)管拔出。

        1.3 評(píng)價(jià)指標(biāo) 兩組患者術(shù)后分別于2 h(T1)、4 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)和48 h(T6)對(duì)患者疼痛情況和鎮(zhèn)靜情況進(jìn)行評(píng)估,疼痛情況評(píng)估采用視覺(jué)模擬評(píng)分法(VAS法):0分為無(wú)痛,10分為疼痛難以忍受[6];鎮(zhèn)靜情況采用Ramsy鎮(zhèn)靜評(píng)級(jí)法:共分為6級(jí),根據(jù)患者意識(shí)清醒情況和對(duì)刺激反應(yīng)情況進(jìn)行評(píng)定[7]。記錄兩組患者不良反應(yīng)情況。

        1.4 統(tǒng)計(jì)學(xué)處理 利用SPSS 17.0統(tǒng)計(jì)處理軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料采用(x±s)表示,組間比較采用t檢驗(yàn),計(jì)數(shù)資料采用率表示,組間比較采用 字2檢驗(yàn),P<0.05為差異具有統(tǒng)計(jì)學(xué)意義。

        2 結(jié)果

        2.1 兩組患者術(shù)后不同時(shí)點(diǎn)疼痛評(píng)分情況比較 術(shù)后對(duì)兩組患者不同時(shí)點(diǎn)疼痛情況進(jìn)行評(píng)估,聯(lián)合組患者不同時(shí)點(diǎn)疼痛評(píng)分均低于對(duì)照組,差異均具有統(tǒng)計(jì)學(xué)意義(P<0.05),詳見(jiàn)表1。

        2.2 兩組患者術(shù)后不同時(shí)點(diǎn)鎮(zhèn)靜評(píng)級(jí)情況比較 術(shù)后對(duì)兩組患者不同時(shí)點(diǎn)鎮(zhèn)靜評(píng)級(jí)情況進(jìn)行評(píng)估,聯(lián)合組患者不同時(shí)點(diǎn)鎮(zhèn)靜評(píng)級(jí)與對(duì)照組比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),詳見(jiàn)表2。

        2.3 兩組患者術(shù)后不良反應(yīng)發(fā)生情況 對(duì)兩組患者術(shù)后不良反應(yīng)情況進(jìn)行分析,聯(lián)合組患者頭暈頭痛、惡性嘔吐、躁動(dòng)、皮膚瘙癢、呼吸抑制等不良反應(yīng)例數(shù)均少于對(duì)照組,除惡心嘔吐發(fā)生率差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)外,其他差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),聯(lián)合組總不良反應(yīng)發(fā)生率為12.5%,顯著低于對(duì)照組的52.1%,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),詳見(jiàn)表3。

        3 討論

        心臟搭橋術(shù)是目前心外科開(kāi)展較多的手術(shù),由于該手術(shù)需要進(jìn)行胸骨劈開(kāi)開(kāi)展手術(shù),刀口較長(zhǎng)、創(chuàng)傷較大,患者術(shù)后疼痛一般會(huì)比較劇烈,如若不能很好地進(jìn)行術(shù)后鎮(zhèn)痛治療,常會(huì)引發(fā)患者機(jī)體應(yīng)激性反應(yīng),而不利于術(shù)后恢復(fù),影響手術(shù)治療效果[8]。同時(shí),劇烈疼痛還將導(dǎo)致肌張力增加,使患者正常呼吸頻率減少,引起患者呼吸不暢,導(dǎo)致患者缺氧。同時(shí),患者不敢咳嗽,痰液無(wú)法正常排出,容易引發(fā)肺部感染[9]。因此,良好的術(shù)后鎮(zhèn)痛對(duì)于心臟搭橋術(shù)顯得尤為重要,不僅有利于提高患者術(shù)后舒適度,而且有利于減少由于疼痛導(dǎo)致的并發(fā)癥,目前,臨床上常用單一的藥物進(jìn)行術(shù)后鎮(zhèn)痛,在起到鎮(zhèn)痛作用的同時(shí),可能會(huì)帶來(lái)其他不良反應(yīng),而多種鎮(zhèn)痛藥物聯(lián)合使用,則可以彌補(bǔ)相互之間的不足,最大限度起到鎮(zhèn)痛作用的同時(shí),減少其他并發(fā)癥的產(chǎn)生[10]。本研究通過(guò)將氟比洛芬酯聯(lián)合地佐辛用于心臟搭橋術(shù)后鎮(zhèn)痛,取得了較好的臨床鎮(zhèn)痛效果。

        氟比洛芬酯是一種新型非甾體類(lèi)鎮(zhèn)痛藥,具有靶向性,靜脈注射后可以有選擇性地集中在手術(shù)切口處,能夠促進(jìn)藥物吸收,縮短起效時(shí)間,改變藥物的體內(nèi)分布;同時(shí)能夠通過(guò)抑制COX從而減少前列腺素合成,降低受傷感受器的興奮性而起到鎮(zhèn)痛作用[11]。地佐辛是新型阿片類(lèi)鎮(zhèn)痛藥,是一種κ受體激動(dòng)劑,鎮(zhèn)痛效果要強(qiáng)于嗎啡等藥物,且不良反應(yīng)較少[12]。芬太尼是一種常用的人工合成的鎮(zhèn)痛藥物,鎮(zhèn)痛作用強(qiáng),是普通嗎啡鎮(zhèn)痛效果的100倍,但臨床上不良反應(yīng)較多,在一定程度上限制了該藥物的使用[13]。本研究顯示,聯(lián)合組患者術(shù)后不同時(shí)點(diǎn)疼痛評(píng)分均低于單一用藥組,差異均具有統(tǒng)計(jì)學(xué)意義(P<0.05),聯(lián)合組患者不同時(shí)點(diǎn)鎮(zhèn)靜評(píng)級(jí)與單一用藥組差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),說(shuō)明聯(lián)合用藥可以增強(qiáng)鎮(zhèn)痛效果,比單一使用芬太尼療效好,而鎮(zhèn)靜效果與芬太尼無(wú)差異,與鞏繼平等[14]研究結(jié)論相同。本研究顯示,聯(lián)合組患者頭暈頭痛、惡心嘔吐、躁動(dòng)、皮膚瘙癢、呼吸抑制等不良反應(yīng)例數(shù)均少于對(duì)照組,除惡心嘔吐發(fā)生率差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)外,其他差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),聯(lián)合組總不良反應(yīng)發(fā)生率為12.5%,顯著低于對(duì)照組的52.1%,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),說(shuō)明聯(lián)合用藥能夠有效降低不良反應(yīng)的產(chǎn)生,不良反應(yīng)發(fā)生率遠(yuǎn)低于芬太尼單一用藥鎮(zhèn)痛。endprint

        綜述所述,氟比洛芬酯聯(lián)合地佐辛用于心臟搭橋術(shù)后鎮(zhèn)痛具有較好的鎮(zhèn)痛和鎮(zhèn)靜效果,能夠有效減少單一用藥時(shí)不良反應(yīng)的發(fā)生,是一種安全有效的術(shù)后鎮(zhèn)痛方式,值得在心臟搭橋術(shù)等創(chuàng)傷性較大的手術(shù)術(shù)后開(kāi)展臨床鎮(zhèn)痛中推廣使用。

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        [4] 王文,顧曉靜,翁燕榕.對(duì)冠心病心臟康復(fù)后護(hù)理的探索[J].中國(guó)醫(yī)學(xué)創(chuàng)新, 2014,11(5):80-82.

        [5] Kumar M, Dayal N, Rautela R S, et al. Effect of intravenous magnesium sulphate on postoperative pain following spinal anesthesia. A randomized double blind controlled study[J].Middle East J Anesthesiol,2013, 22(3):251-256.

        [6] Gulcin Ural S, Yener O, Sahin H, et al. The comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal,oral and intramuscular,in early postoperative period in laparoscopic cholecystectomy operations[J].Pak J Med Sci,2014, 30(1):96-100.

        [7] Kose E A, Honca M, Y?lmaz E, et al. Comparison of effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations in transurethral procedures[J]. Urology, 2012, 79(6):1214-1219.

        [8] 張紅, 劉金玲. 舒芬太尼麻醉用于心血管手術(shù)的多種臨床研究[J]. 中國(guó)醫(yī)學(xué)創(chuàng)新, 2013, 10(13):56-58.

        [9] Bawany F I, Khan M S, Khan A, et al. Skeletonization technique in coronary artery bypass graft surgery reduces the postoperative pain intensity and disability index[J]. J Card Surg, 2014, 29(1):47-50.

        [10] Raksamani K, Wongkornrat W, Siriboon P, et al. Pain management after cardiac surgery: are we underestimating post sternotomy pain?[J]. J Med Assoc Thai, 2013, 96(7):824-828.

        [11] Schachtel B, Aspley S, Shephard A, et al. Onset of action of a lozenge containing flurbiprofen 8.75 mg:a randomized,double-blind, placebo-controlled trial with a new method for measuring onset of analgesic activity[J].Pain,2014,155(2):422-428.

        [12] Zhu Y, Jing G, Yuan W. Preoperative administration of intramuscular dezocine reduces postoperative pain for laparoscopic cholecystectomy[J]. J Biomed Res, 2011, 25(5):356-361.

        [13] 江小亞, 陳奎, 王翠艷, 等. 芬太尼、阿托品、地塞米松復(fù)合異丙酚用于無(wú)痛人工流產(chǎn)的觀察[J]. 中國(guó)醫(yī)學(xué)創(chuàng)新, 2013, 10(27):18-19.

        [14] 鞏繼平, 王培山, 孟瑞霞. 地佐辛和氟比洛芬酯聯(lián)合術(shù)后自控靜脈鎮(zhèn)痛研究[J]. 中國(guó)實(shí)用醫(yī)藥, 2012, 7(16):6-9.

        (收稿日期:2014-03-27) (本文編輯:陳丹云)endprint

        綜述所述,氟比洛芬酯聯(lián)合地佐辛用于心臟搭橋術(shù)后鎮(zhèn)痛具有較好的鎮(zhèn)痛和鎮(zhèn)靜效果,能夠有效減少單一用藥時(shí)不良反應(yīng)的發(fā)生,是一種安全有效的術(shù)后鎮(zhèn)痛方式,值得在心臟搭橋術(shù)等創(chuàng)傷性較大的手術(shù)術(shù)后開(kāi)展臨床鎮(zhèn)痛中推廣使用。

        參考文獻(xiàn)

        [1] Nag T, Ghosh A. Cardiovascular disease risk factors in Asian Indian population:a systematic review[J].J Cardiovasc Dis Res,2013, 4(4):222-228.

        [2] Lala A, Desai A S.The Role of Coronary Artery Disease in Heart Failure[J]. Heart Fail Clin, 2014, 10(2):353-365.

        [3] Sugumar H, Lancefield T F, Andrianopoulos N.Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention[J].Int J Cardiol,2014,172(2):442-449.

        [4] 王文,顧曉靜,翁燕榕.對(duì)冠心病心臟康復(fù)后護(hù)理的探索[J].中國(guó)醫(yī)學(xué)創(chuàng)新, 2014,11(5):80-82.

        [5] Kumar M, Dayal N, Rautela R S, et al. Effect of intravenous magnesium sulphate on postoperative pain following spinal anesthesia. A randomized double blind controlled study[J].Middle East J Anesthesiol,2013, 22(3):251-256.

        [6] Gulcin Ural S, Yener O, Sahin H, et al. The comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal,oral and intramuscular,in early postoperative period in laparoscopic cholecystectomy operations[J].Pak J Med Sci,2014, 30(1):96-100.

        [7] Kose E A, Honca M, Y?lmaz E, et al. Comparison of effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations in transurethral procedures[J]. Urology, 2012, 79(6):1214-1219.

        [8] 張紅, 劉金玲. 舒芬太尼麻醉用于心血管手術(shù)的多種臨床研究[J]. 中國(guó)醫(yī)學(xué)創(chuàng)新, 2013, 10(13):56-58.

        [9] Bawany F I, Khan M S, Khan A, et al. Skeletonization technique in coronary artery bypass graft surgery reduces the postoperative pain intensity and disability index[J]. J Card Surg, 2014, 29(1):47-50.

        [10] Raksamani K, Wongkornrat W, Siriboon P, et al. Pain management after cardiac surgery: are we underestimating post sternotomy pain?[J]. J Med Assoc Thai, 2013, 96(7):824-828.

        [11] Schachtel B, Aspley S, Shephard A, et al. Onset of action of a lozenge containing flurbiprofen 8.75 mg:a randomized,double-blind, placebo-controlled trial with a new method for measuring onset of analgesic activity[J].Pain,2014,155(2):422-428.

        [12] Zhu Y, Jing G, Yuan W. Preoperative administration of intramuscular dezocine reduces postoperative pain for laparoscopic cholecystectomy[J]. J Biomed Res, 2011, 25(5):356-361.

        [13] 江小亞, 陳奎, 王翠艷, 等. 芬太尼、阿托品、地塞米松復(fù)合異丙酚用于無(wú)痛人工流產(chǎn)的觀察[J]. 中國(guó)醫(yī)學(xué)創(chuàng)新, 2013, 10(27):18-19.

        [14] 鞏繼平, 王培山, 孟瑞霞. 地佐辛和氟比洛芬酯聯(lián)合術(shù)后自控靜脈鎮(zhèn)痛研究[J]. 中國(guó)實(shí)用醫(yī)藥, 2012, 7(16):6-9.

        (收稿日期:2014-03-27) (本文編輯:陳丹云)endprint

        綜述所述,氟比洛芬酯聯(lián)合地佐辛用于心臟搭橋術(shù)后鎮(zhèn)痛具有較好的鎮(zhèn)痛和鎮(zhèn)靜效果,能夠有效減少單一用藥時(shí)不良反應(yīng)的發(fā)生,是一種安全有效的術(shù)后鎮(zhèn)痛方式,值得在心臟搭橋術(shù)等創(chuàng)傷性較大的手術(shù)術(shù)后開(kāi)展臨床鎮(zhèn)痛中推廣使用。

        參考文獻(xiàn)

        [1] Nag T, Ghosh A. Cardiovascular disease risk factors in Asian Indian population:a systematic review[J].J Cardiovasc Dis Res,2013, 4(4):222-228.

        [2] Lala A, Desai A S.The Role of Coronary Artery Disease in Heart Failure[J]. Heart Fail Clin, 2014, 10(2):353-365.

        [3] Sugumar H, Lancefield T F, Andrianopoulos N.Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention[J].Int J Cardiol,2014,172(2):442-449.

        [4] 王文,顧曉靜,翁燕榕.對(duì)冠心病心臟康復(fù)后護(hù)理的探索[J].中國(guó)醫(yī)學(xué)創(chuàng)新, 2014,11(5):80-82.

        [5] Kumar M, Dayal N, Rautela R S, et al. Effect of intravenous magnesium sulphate on postoperative pain following spinal anesthesia. A randomized double blind controlled study[J].Middle East J Anesthesiol,2013, 22(3):251-256.

        [6] Gulcin Ural S, Yener O, Sahin H, et al. The comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal,oral and intramuscular,in early postoperative period in laparoscopic cholecystectomy operations[J].Pak J Med Sci,2014, 30(1):96-100.

        [7] Kose E A, Honca M, Y?lmaz E, et al. Comparison of effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations in transurethral procedures[J]. Urology, 2012, 79(6):1214-1219.

        [8] 張紅, 劉金玲. 舒芬太尼麻醉用于心血管手術(shù)的多種臨床研究[J]. 中國(guó)醫(yī)學(xué)創(chuàng)新, 2013, 10(13):56-58.

        [9] Bawany F I, Khan M S, Khan A, et al. Skeletonization technique in coronary artery bypass graft surgery reduces the postoperative pain intensity and disability index[J]. J Card Surg, 2014, 29(1):47-50.

        [10] Raksamani K, Wongkornrat W, Siriboon P, et al. Pain management after cardiac surgery: are we underestimating post sternotomy pain?[J]. J Med Assoc Thai, 2013, 96(7):824-828.

        [11] Schachtel B, Aspley S, Shephard A, et al. Onset of action of a lozenge containing flurbiprofen 8.75 mg:a randomized,double-blind, placebo-controlled trial with a new method for measuring onset of analgesic activity[J].Pain,2014,155(2):422-428.

        [12] Zhu Y, Jing G, Yuan W. Preoperative administration of intramuscular dezocine reduces postoperative pain for laparoscopic cholecystectomy[J]. J Biomed Res, 2011, 25(5):356-361.

        [13] 江小亞, 陳奎, 王翠艷, 等. 芬太尼、阿托品、地塞米松復(fù)合異丙酚用于無(wú)痛人工流產(chǎn)的觀察[J]. 中國(guó)醫(yī)學(xué)創(chuàng)新, 2013, 10(27):18-19.

        [14] 鞏繼平, 王培山, 孟瑞霞. 地佐辛和氟比洛芬酯聯(lián)合術(shù)后自控靜脈鎮(zhèn)痛研究[J]. 中國(guó)實(shí)用醫(yī)藥, 2012, 7(16):6-9.

        (收稿日期:2014-03-27) (本文編輯:陳丹云)endprint

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