發(fā)布時(shí)間：2018-01-24 10:20

  本文關(guān)鍵詞： 右美托咪定 氣管拔管 血流動(dòng)力學(xué) 呼吸 BIS值　出處：《職業(yè)衛(wèi)生與病傷》2016年02期 　論文類型：期刊論文

【摘要】：目的探討腹部術(shù)中全麻處理時(shí),右美托咪定對(duì)患者蘇醒期血流動(dòng)力學(xué)、呼吸、BIS值的影響。方法選取宜賓市礦山急救醫(yī)院2014-01/2015-06接診的擇期全麻開(kāi)腹手術(shù)患者57例,按照隨機(jī)數(shù)字排列法將其分為兩組,其中對(duì)照組患者27例,給予10ml生理鹽水,觀察組患者27例,給予其0.6μg/kg右美托咪定,術(shù)中以氧氣、七氟醚、芬太尼、阿曲庫(kù)銨行維持麻醉,手術(shù)結(jié)束前30min,經(jīng)靜脈泵入試驗(yàn)藥物。觀測(cè)兩組患者手術(shù)指標(biāo)、各時(shí)間點(diǎn)血流動(dòng)力學(xué)、呼吸、BIS值變化,測(cè)定鎮(zhèn)痛效果,記錄鎮(zhèn)痛時(shí)間。結(jié)果兩組患者手術(shù)時(shí)間、麻醉時(shí)間、尿量、丙泊酚與芬太尼使用劑量、術(shù)中輸液量與出血量對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組入室時(shí)、用藥時(shí)、用藥后5min SBP、DBP對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);觀察組用藥后10min SBP高于對(duì)照組,拔管時(shí)、拔管后3min、5min、10min SBP較之對(duì)照組更低(P0.05);觀察組拔管時(shí)、拔管后3min、5min、10min DBP較之對(duì)照組更低(P0.05),兩組入室時(shí)、用藥時(shí)、用藥后5min HR對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);觀察組用藥后10min、拔管時(shí)、拔管后3min、5min、10min HR較之對(duì)照組更低(P0.05);兩組入室時(shí)RPP對(duì)比差異(P0.05);觀察組拔管時(shí)、拔管后1min、3min、5min RPP較之對(duì)照組更低(P0.05);兩組入室時(shí)、用藥時(shí)、用藥后5min、10min、拔管時(shí)、拔管后3min、5min、10min BIS值測(cè)定結(jié)果對(duì)比無(wú)差異(P0.05);觀察組自主呼吸恢復(fù)時(shí)間更短,術(shù)后2h VAS評(píng)分更低,術(shù)后鎮(zhèn)痛時(shí)間更長(zhǎng)(P0.05);觀察組手術(shù)費(fèi)與對(duì)照差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),但住院時(shí)間更短(P0.05);對(duì)照組不良反應(yīng)率為14.81%,觀察組不良反應(yīng)率為7.41%(P0.05)。結(jié)論腹部手術(shù)全麻處理中,運(yùn)用右美托咪定可有效減輕患者的拔管應(yīng)激反應(yīng),尤其是在穩(wěn)定血流動(dòng)力學(xué)上效果顯著,且不會(huì)對(duì)呼吸造成過(guò)大影響,同時(shí)還具有較好的鎮(zhèn)痛效果。
[Abstract]:Objective to investigate the effects of dexmetomidine on hemodynamics and respiration during abdominal anesthesia. Methods 57 patients undergoing elective general anesthesia operation in Yibin Mine Emergency Hospital 2014-01 / 2015-06 were divided into two groups according to random number arrangement. The control group (n = 27) received 10 ml normal saline, while the observation group (n = 27) received 0.6 渭 g / kg dexmetidine with oxygen, sevoflurane and fentanyl during the operation. Atracurium was administered with maintenance anesthesia, 30 minutes before the end of the operation, and then administered intravenously into the trial drug. The indexes of operation, hemodynamics at each time point, the changes of BIS in respiratory system and the analgesic effect were measured. Results there was no significant difference in operation time, anesthesia time, urine volume, dosage of propofol and fentanyl, intraoperative infusion volume and blood loss between the two groups (P 0.05). There was no significant difference in SBPnDBP between the two groups at 5 min after the treatment, and there was no significant difference in DBP between the two groups (P 0.05). The SBP of the observation group was significantly lower than that of the control group (P 0.05), and the SBP of the observation group was significantly lower than that of the control group (P 0.05) 3 minutes after extubation and 5 minutes after the extubation. During extubation, the DBP of the observation group was lower than that of the control group 3 minutes after extubation and 5 minutes after extubation. There was no significant difference in HR at 5 min after treatment (P 0.05). The HR in the observation group was lower than that in the control group at 10 min after medication, 5 min after extubation and 3 min after extubation. The difference of RPP between the two groups was P0.05A; During extubation, the RPP of the observation group was lower than that of the control group at 3 minutes and 5 minutes after extubation. There was no significant difference in BIS values between the two groups at the time of entering the room, 5 minutes after the administration of drugs and 3 minutes after extubation, and 5 minutes after extubation, and there was no difference between the two groups in the determination of BIS value (P 0.05). In the observation group, the recovery time of spontaneous respiration was shorter, the VAS score was lower at 2 hours after operation, and the postoperative analgesia time was longer than that of the control group (P 0.05). The operating expenses of the observation group were not significantly different from those of the control group (P 0.05), but the hospitalization time was shorter than that of the control group (P 0.05). The adverse reaction rate was 14.81 in the control group and 7.41 in the observation group. Dexmetomidine can effectively reduce the extubation stress response, especially in stabilizing hemodynamics, and does not have too much effect on respiration, but also has a good analgesic effect.
【作者單位】： 四川省宜賓市礦山急救醫(yī)院;
【分類號(hào)】：R614.2
【正文快照】： 在全麻蘇醒期氣管拔管時(shí),會(huì)對(duì)機(jī)體產(chǎn)生刺激,致使其出現(xiàn)強(qiáng)烈的應(yīng)激反應(yīng),并引起下丘腦-垂體-腎上腺皮質(zhì)軸興奮,使得患者出現(xiàn)血壓上升、心動(dòng)過(guò)速、心肌耗氧量增加等表現(xiàn),極不利于患者的愈后和轉(zhuǎn)歸[1]。右美托咪定是一種新型的α2腎上腺素能受體激動(dòng)劑,半衰期大約為6 min,消除半衰

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