喷他佐辛超前镇痛对脊柱外科内固定手术苏醒应激反应的影响

Application of history taking method manual to physician training at Guangxi basic medical services

目的评价喷他佐辛超前镇痛对脊柱外科内固定手术苏醒期应激反应的影响,为临床的合理用药提供参考。方法选择2012年该院脊柱外科内固定手术80例,ASAⅠ、Ⅱ级,年龄30～75岁。随机分成空白对照组（A组）、小剂量喷他佐辛组（B1组）、中剂量喷他佐辛组（B2组）及大剂量喷他佐辛组（B3组）。每组20例。B1、B2和B3组在全身麻醉诱导后静脉分别给予喷他佐辛0.6、1.2和1.8 mg/kg,观察并记录拔管即刻（T1）、拔管后3 min（T2）、5 min（T3）、10 min（T3）、15 min（T4）的镇静躁动评分（SAS）、平均动脉压（MAP）、心率（HR）与血浆皮质醇水平（Cor）、拔管时间、苏醒时间,以及患者术后12 h呼吸抑制、恶心、呕吐等不良反应。结果与A组相比,其余3组T1～T4的SAS评分、MAP、HR、Cor下降,差异有统计学意义（P〈0.05）;与B1组相比,B2组,B3组T1～T4的SAS评分、MAP、HR、Cor下降,差异有统计学意义（P〈0.05）,B2与B3组T1～T4的SAS评分、MAP、HR、Cor差异无统计学意义（P〉0.05）,A、B1、B2组苏醒时间、拔管时间差异无统计学意义（P〉0.05）,与A、B1、B2组比较,B3组苏醒时间和拔管时间延长,且呼吸抑制、恶性呕吐不良反应的发生率高,差异有统计学意义（P〈0.05）。结论 1.2 mg/kg剂量的喷他佐辛超前镇痛明显减轻脊柱外科内固定手术全身麻醉苏醒期的应激反应,且不良反应的发生率低。

[ Objective] To explore the application outcomes of history taking method manual to physician training at Guangxi basic medical services. [Methods] The history taking method manual was composed in accordance with the skill-evaluating standards of Chinese National Physician Licensing Test. During the training, the manual was fully utilized. Before and after the training, physicians at targeted training units were drawn to respond to a questionnaire survey. All responders answered and returned the questionnaire on the spot. Before and after training, the knowledge and proficiency of history training were compared for the trainees. [Results] A total of 477 physicians participated in the examination of history taking. Prior to the training, 477 questionnaires were distributed and 436 returned as valid. The average score of history taking examination was （96.4 ± 6.8） points with a passing rate of 9.86%. After the training, 477 questionnaires were distributed and 468 returned as valid. The average score of history taking examination was （132.8 ± 12.6） points with a passing rate of 100%. Before and after the training, the proficiency of history taking had marked differences with statistical significance （P〈0.01）. [Conclusion] Using history taking method manual at training units for centralized theory lectures will greatly boost the history taking capacities of physicians at Guangxi basic medical services so as to offer reliable supports for disease diagnosis and treatment.