發(fā)布時(shí)間：2017-12-31 06:19

  本文關(guān)鍵詞：不同劑量右美托咪啶預(yù)防小兒蘇醒期躁動(dòng)的臨床效果　出處：《延邊大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 小兒全麻 蘇醒期躁動(dòng) 右美托咪啶 全憑靜脈麻醉

【摘要】：目的觀察不同劑量右美托咪啶減少術(shù)后躁動(dòng)發(fā)生率的效果,為臨床選擇適宜的劑量提供參考依據(jù)。方法隨機(jī)選取同時(shí)行扁桃體和腺樣體切除3～6歲小兒60例,隨機(jī)分為A組泵注右美托咪啶1ug/kg,B組泵注右美托咪啶0.5ug/kg,C組泵注鹽水組,每組20例。監(jiān)測(cè)和記錄入PACU(T1)、拔管前(T2)、拔管時(shí)(T3)等時(shí)刻的MAP、HR變化情況;對(duì)全麻蘇醒期躁動(dòng)情況進(jìn)行評(píng)分、且統(tǒng)計(jì)出躁動(dòng)的發(fā)生比例、記錄相關(guān)麻醉時(shí)間,將所得數(shù)據(jù)通過(guò)五級(jí)躁動(dòng)評(píng)分表進(jìn)行評(píng)分處理(4分躁動(dòng));觀察研究對(duì)象在蘇醒時(shí)間、躁動(dòng)發(fā)生情況和嚴(yán)重性,且對(duì)嘔吐、嗆咳等反應(yīng)進(jìn)行觀察和記錄;記錄拔除氣管四小時(shí)內(nèi)的鎮(zhèn)靜程度評(píng)分(判斷是否滿足鎮(zhèn)靜要求)。結(jié)果(1)C組患兒全麻蘇醒期間躁動(dòng)發(fā)生率(16例,80%)明顯高于A組(2例,10%)和B組(6例,30%),三組間比較有統(tǒng)計(jì)學(xué)差異(P0.05)(2)A組(拔管時(shí)MAP80±13HR98±13,拔管后MAP82±11HR96±12)和8組(拔管時(shí)MA82±12 HR 108±14,拔管后MAP 83±10 HR 106±13)患兒在蘇醒拔管時(shí)、拔管后血流動(dòng)力學(xué)較C組(拔管時(shí)MAP 94±12 HR 128±20,拔管后MAP 97±14 HR 130±21)更為平穩(wěn),有統(tǒng)計(jì)學(xué)差異(P0.05)。(3)與C組(拔管后1h0.7±0.4、2h1.1±0.5、3h1.5±0.4、4h1.6±0.7)相比,A組(拔管后 1h 1.5±0.5、2h 1.9±0.4、3h 2.3±0.7、4h 2.8±0.6)和 B 組(拔管后 1h 1.3±0.8、2h 1.6±0.4、3h1.7±0.3、4h2.2±0.4)拔管后 1～4hRamsay 鎮(zhèn)靜評(píng)分高,,有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論在全麻誘導(dǎo)時(shí)泵注右美托咪啶可有效降低小兒扁桃體、腺樣體切除術(shù)后躁動(dòng)發(fā)生率,拔管期間血流動(dòng)力學(xué)更平穩(wěn)、術(shù)后4小時(shí)安靜睡眠率高,且泵注右美托咪啶高劑量組效果更佳。
[Abstract]:Objective to observe the effect of different doses of dexmetidine on the reduction of postoperative restlessness. Methods 60 children aged 3 to 6 years old who underwent tonsillectomy and adenoidectomy were randomly divided into two groups: group A: right metomidine 1 ug-1 / kg by pump. Group B was injected with dexmetidine 0.5ug- kg ~ (-1) in saline group (n = 20). The MAP was monitored and recorded in PACUT _ (1), T _ (2) before extubation, and T _ (3) during extubation. HR changes; The restlessness during the general anesthesia recovery period was scored, and the occurrence ratio of restlessness was calculated, and the relevant anesthetic time was recorded, and the data were graded through the five-grade restlessness score table (4 minutes restlessness). The subjects were observed and recorded in the recovery time, the occurrence and severity of restlessness, and the responses to vomiting and cough. The score of sedation degree within 4 hours after tracheal extubation (to judge whether the sedation requirement was satisfied or not) was significantly higher in group C than in group A (n = 16, n = 80) during general anesthesia recovery, and was significantly higher than that in group A (n = 2). There was significant difference between group B and group B (MAP80 鹵13HR98 鹵13). After extubation, MAP82 鹵11HR96 鹵12) and group 8 (MA82 鹵12 HR108 鹵14 at extubation). The hemodynamics after extubation in MAP 83 鹵10 HR 106 鹵13) was higher than that in C group (MAP 94 鹵12 HR 128 鹵20 at extubation). After extubation, MAP (97 鹵14 HR, 130 鹵21) was more stable, there was statistical difference between group C and group C (0. 7 鹵0. 4 at 1h after extubation). 2h1.1 鹵0.5h1.5 鹵0.4h1.6 鹵0.7) compared with group A (1.5 鹵0.5h2h after extubation, 1.9 鹵0.4). 3 h 2.3 鹵0.7 h 2.8 鹵0.6) and B group (1 h 1.3 鹵0.82 h 1.6 鹵0.4 h 1.7 鹵0.3). 4 h 2.2 鹵0.4) Ramsay sedation score was high at 1h and 4h after extubation. There was a significant difference (P 0.05). Conclusion pump injection of dexmetidine can effectively reduce the incidence of restlessness after adenoidectomy during general anesthesia induction, and the hemodynamics is more stable during extubation. The rest sleep rate was high 4 hours after operation, and the effect of high dose dexmemetidine was better.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.1

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