本文選題：右美托咪定　切入點(diǎn)：腹腔鏡手術(shù)　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的評(píng)價(jià)右美托咪定在婦科腫瘤腹腔鏡手術(shù)中應(yīng)用的安全性及對(duì)患者全麻蘇醒期的影響以及不良反應(yīng)發(fā)生情況。方法選擇全麻下?lián)衿谛懈骨荤R下婦科腫瘤根治術(shù)患者45例,年齡18~65歲,ASA I~II級(jí),術(shù)中采用靶控輸注瑞芬太尼及丙泊酚的麻醉方案,隨機(jī)分成3組(n=15),D1組(0.3ug/kg/h右美托咪定組):從麻醉誘導(dǎo)到手術(shù)結(jié)束前30分鐘,持續(xù)輸注0.3ug/kg/h右美托咪定;D2組(0.4ug/kg/h右美托咪定組):從麻醉誘導(dǎo)到手術(shù)結(jié)束前30分鐘,持續(xù)輸注0.4ug/kg/h右美托咪定;C組為對(duì)照組。記錄入室時(shí)(T1)、手術(shù)結(jié)束時(shí)(T2)、拔管前(T3)、拔管時(shí)(T4)、拔管后5min(T5)、拔管后10min(T6)及拔管后30min(T7)的收縮壓(SBP)、舒張壓(DBP)、心率(HR)、平均動(dòng)脈壓(MAP);記錄患者T3~T7時(shí)點(diǎn)Ramsay鎮(zhèn)靜評(píng)分、Riker鎮(zhèn)靜-躁動(dòng)評(píng)分及嗆咳評(píng)分;記錄麻醉藥用量、呼吸恢復(fù)時(shí)間、蘇醒時(shí)間、拔管時(shí)間;記錄術(shù)中心率50次/分、低血壓、高血壓及術(shù)后呼吸抑制、惡心嘔吐、寒戰(zhàn)等不良反應(yīng)的發(fā)生率。結(jié)果(1)與C組比較,D1、D2組丙泊酚及瑞芬太尼用量明顯減少,差異有統(tǒng)計(jì)學(xué)意義(P0.05);D2組與D1組的丙泊酚及瑞芬太尼用量差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)(2)與C組比較,T3、T4、T5時(shí)點(diǎn)D1、D2組的Ramsay鎮(zhèn)靜評(píng)分升高,T3~T7時(shí)點(diǎn)D2組的Ramsay鎮(zhèn)靜評(píng)分升高,T3、T4時(shí)點(diǎn)D1、D2組患者的Riker鎮(zhèn)靜-躁動(dòng)評(píng)分SAS降低,T3時(shí)點(diǎn)D1、D2組嗆咳評(píng)分降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);與D1組比較,T3、T4、T5時(shí)點(diǎn)D2組的Ramsay鎮(zhèn)靜評(píng)分更高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),D2組的Riker鎮(zhèn)靜-躁動(dòng)評(píng)分SAS、T3時(shí)點(diǎn)D2組嗆咳評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);(3)與C組比較,T4時(shí)點(diǎn)D2組的SBP、DBP、MAP、HR值降低及D1組的SBP、DBP值降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);T3、T4、T5時(shí)點(diǎn)D1、D2組的值基本低于C組,D1、D2組拔管期的血流動(dòng)力學(xué)比C組更加平穩(wěn)。(4)三組不良反應(yīng)發(fā)生率無(wú)明顯差別。結(jié)論腹腔鏡下婦科腫瘤根治手術(shù)術(shù)中持續(xù)輸注0.3ug/kg/h、0.4ug/kg/h的右美托咪定可有效抑制全身麻醉蘇醒拔管期應(yīng)激反應(yīng),且在穩(wěn)定血流動(dòng)力學(xué)的同時(shí)又達(dá)到良好的鎮(zhèn)靜效果;0.4ug/kg/h右美托咪定組在蘇醒期的鎮(zhèn)靜效果優(yōu)于0.3ug/kg/h右美托咪定組,提高了患者蘇醒拔管期的舒適度,同時(shí)并未增加不良反應(yīng)的發(fā)生率。
[Abstract]:Objective to evaluate the safety of dexmetomidine in gynecological tumor laparoscopic surgery and its influence on the recovery period of general anesthesia and adverse reactions. Methods 45 patients with gynecologic tumor underwent laparoscopic radical gynecologic tumor surgery under general anesthesia. The patients, aged 18 to 65, were treated with target-controlled infusion of remifentanil and propofol. They were randomly divided into 3 groups: group D: 0.3ugr / kg / h dexmetomidine: 30 minutes from induction of anesthesia to the end of operation. Continuous infusion of 0.3 ugr / kg / h dexmetomidine D2 group: 30 minutes from anesthesia induction to the end of the operation. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HRT), mean arterial pressure (MAPP) were recorded in group C (0.4 ugg / kg / h) as control group. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HRT), mean arterial pressure (MAPP) were recorded at the end of operation, before extubation, at 5 min after extubation, 5 min after extubation, 10 min after extubation, 10 min after extubation, 30 min after extubation, and 30 min after extubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HRT) and mean arterial pressure (MAPP) were recorded. Ramsay sedation score, Riker sedation-restlessness score and cough score at T _ 3 and T _ 7; The dosage of anesthetic, the time of respiratory recovery, the time of waking up, the time of extubation, the heart rate of 50 / min, hypotension, hypertension and postoperative respiratory depression, nausea and vomiting were recorded. Results compared with group C, the dosage of propofol and remifentanil in D1D 2 group decreased significantly. There was no significant difference in the dosage of propofol and remifentanil between group D 2 and group D1. There was no significant difference in the dosage of propofol and remifentanil between group D 2 and group D 1. There was no significant difference between group C and group C (P < 0.05). The Ramsay sedation score of group D 2 was higher than that of group C (P < 0.01). The Ramsay sedation score of group D _ 2 was higher than that of group C at T _ 3, T _ 4, T _ 2, T _ 3, T _ 7, D _ 2 and D _ 1T _ 4. The Riker sedative-restlessness score (SAS) decreased at T _ 3 and D _ 1 / D _ 2 group, and the score of cough was decreased in D _ 1 / D _ 2 group. Compared with D1 group, the Ramsay sedation score of D2 group was higher than that of D1 group. There was no significant difference in Riker sedation and restlessness score between group D 2 and group C (P 0.05). There was no significant difference in score of cough and choking between group D 2 and group C (P < 0.05). The HR value of SBP DBP in group D 2 at T 4 was lower than that in group D 1, and that in group D 1 was lower than that in group D 1. There was no significant difference in the incidence of adverse reactions among the three groups. Conclusion there is no significant difference in the incidence of adverse reactions among the three groups. Conclusion Laparoscopic radical resection of gynecological tumors is not a significant difference among the three groups. Continuous intraoperative infusion of 0.3ugr / kg / kg / h dexmetomidine could effectively inhibit the stress response during the extubation phase of general anesthesia. At the same time of stabilizing hemodynamics and achieving good sedative effect, the sedative effect of the right metoimidine group was better than that of the 0.3ugr / kg / h dexmetomidine group during the recovery period, which improved the comfort of the patients during the extubation period. At the same time, there was no increase in the incidence of adverse reactions.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614;R737.3

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