中西医结合护理 (Jul 2022)
Application of compound lidocaine cream for preemptive analgesia in placement of stereotactic head frames for Gamma Knife treatment (复方利多卡因乳膏超前镇痛在伽玛刀治疗固定立体定位头架中的应用)
Abstract
Objective To compare the pain and stress reaction of patients with topical anesthesia using local lidocaine injection and topical anesthesia using local lidocaine injection combined with compound lidocaine cream in advance in the placement of stereotactic head frames for Gamma Knife treatment. Methods Totally 438 patients were randomly divided into experimental group (n = 219) and control group (n = 219). In the experimental group, 5% compound lidocaine cream was applied at the two points behind the forehead pillow 1 hour before placement of skull fixed stereotactic head frames, and then the stereotactic head frame was installed after local drug infiltration and local anesthesia with lidocaine injection. In the control group, the stereotactic head frame was placed after topical anesthesia using local lidocaine injection. Visual analogue scale (VAS) score was used for pain self-assessment, and Faces Pain Scale Revised (FPS-R) was used to objectively determine the degree of facial expression pain. The pain score and grading were performed before, during and after fixation, and the changes of mean arterial pressure and heart rate before and after the placement of head frames under stress. Results There was no significant difference in VAS score, FPS-R grade, mean arterial pressure and heart rate between the two groups before fixation (P>0. 05), while the VAS score of the experimental group and the control group decreased significantly during fixation (P 0. 05)。固定过程中, 研究组与对照组的VAS评分明显降低, 差异有统计学意义(P<0. 0001); 研究组的FPS-R疼痛分级轻痛多于对照组, 差异有统计学意义(P<0. 001)。固定后5 min研究组的VAS评分低于对照组, 差异有统计学意义(P<0. 0001); 研究组的FPS-R疼痛分级无痛多于对照组, 差异有统计学意义(P<0. 001)。固定后研究组立即测得平均动脉压低于对照组, 差异有统计学意义(P<0. 001); 固定后研究组立即测得心率低于对照组, 差异有统计学意义(P<0. 05)。结论 伽玛刀治疗固定立体定位头架前给予5%复方利多卡因乳膏涂抹钉位处可产生良好的超前镇痛效果, 对于降低头架安装过程中因疼痛产生的晕厥、癫痫等发生具有积极意义, 能够增加治疗过程中的舒适度。)
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