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  本文關鍵詞： 右美托咪定 異丙酚 咪達唑侖 心功能 超聲心動圖　出處：《蘇州大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的觀察右美托咪定、異丙酚、咪達唑侖對重癥監(jiān)護室（ICU）老年患者心功能的影響。 方法選取消化道腫瘤術后呼吸功能不全的ICU老年患者30例，ASA分級II或III級，隨機分入右美托咪定組、異丙酚組、咪達唑侖組，每組10例。入室后2小時判斷患者已經(jīng)麻醉蘇醒后予以鎮(zhèn)靜。右美托咪定組靜脈泵注負荷劑量為1ug/kg的右美托咪定10min，維持劑量為0.4ug/kg/h，調整劑量時每次增減0.1ug/kg/h。異丙酚組靜脈泵注初始血漿濃度為0.5ug/ml的異丙酚，誘導時間為10min，調整劑量時每次增減0.1ug/ml。咪達唑侖組靜脈泵注初始血漿濃度為30ng/ml的咪達唑侖，誘導時間為10min，調整劑量時每次增減10ng/ml。各組每隔30min進行改良OAA/S評分并調整劑量，使評分保持在3~4級。分別在鎮(zhèn)靜前（T0）、鎮(zhèn)靜60min（T1）、鎮(zhèn)靜120min（T2）、鎮(zhèn)靜180min（T3）4個時間點，，用超聲心動圖監(jiān)測患者的心功能情況。 結果右美托咪定組T1時間點的射血分數(shù)（EF）、縮短分數(shù)（FS）較異丙酚組升高（P＜0.05）；與鎮(zhèn)靜前T0時間點比較，異丙酚組T1、T3時間點的二尖瓣血流E峰速度下降（P＜0.05）；異丙酚組T1時間點的二尖瓣血流E峰速度較右美托咪定組、咪達唑侖組下降（P＜0.05）；其余心功能指標組間、組內比較，差異無統(tǒng)計學意義（P＞0.05)。 結論EF值、E峰速度變化受多種因素影響，統(tǒng)計有差異，但具體臨床應用中影響是微乎其微的。故淺鎮(zhèn)靜劑量的右美托咪定、異丙酚、咪達唑侖對心室收縮、舒張功能無明顯影響。
[Abstract]:Objective to observe the effects of dexmetomidine, propofol and midazolam on cardiac function in elderly patients with ICU. Methods Thirty elderly ICU patients with dyspnea after digestive tract tumor operation were randomly divided into dexmetomidine group, propofol group and midazolam group. 10 patients in each group were treated with sedation after 2 hours of anaesthesia recovery. The dexmetomidine group was injected with dexmetomidine at a dose of 1ugm-1 / kg for 10 minutes. The maintenance dose was 0.4ugr / kg / h, and the dosage was increased or decreased by 0.1ug- / kg / h. Propofol was injected intravenously with propofol with initial plasma concentration of 0.5ugrml. The induction time was 10 min, and the initial plasma concentration of 30 ng / ml midazolam was injected by intravenous pump, and the induction time was 10 min. The dosage was increased or decreased by 10 ng / ml every time. The OAA/S score was improved every 30 minutes and the dose was adjusted to keep the score at 3ng / ml, respectively before sedation (T0). Cardiac function was monitored by echocardiography at 4 time points of sedation (60 min, 120 min, T 2, 180 min, T 3). Results compared with propofol group, the ejection fraction (EFF) and the shortening fraction (FSs) of dexmetomidine group were significantly higher than those of propofol group (P < 0.05). The E peak velocity of mitral flow in propofol group was decreased at T 1 T 3 time point compared with that at T 0 time point before sedation (P < 0 05). The E peak velocity of mitral flow in propofol group was lower than that in right metoimidine group and midazolam group (P < 0.05). There was no significant difference in other cardiac function indexes between groups (P > 0.05). Conclusion the changes of EF value and E peak velocities are influenced by many factors, and there are statistical differences, but the effect in clinical application is very little. So the superficial sedative dosage of dexmetomidine and propofol. Midazolam had no effect on ventricular systolic and diastolic function.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

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