本文關鍵詞： 耳穴埋針 TCI 丙泊酚 瑞芬太尼 BIS　出處：《福建中醫(yī)藥大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：本研究旨在評估耳穴埋針結合靶控輸注技術在腹股溝疝手術的麻醉中對丙泊酚-瑞芬太尼靜脈麻醉的輔助作用。 方法：選取普外科腹外疝50例擇期手術患者,ASA I或Ⅱ級,隨機分為耳針組和對照組各25例。對照組：丙泊酚+瑞芬太尼；耳針組：對照組基礎上加耳穴埋針病側腹股溝穴、肝臟、皮質(zhì)下、神門穴�；颊呷胧液筮B接監(jiān)測儀,進行ECG、血壓、脈搏血氧飽和度(SpO2)監(jiān)測,同時連續(xù)動態(tài)監(jiān)測腦電雙頻譜指數(shù)(BIS)。耳針組,用對壓法相對壓迫貼于耳穴的膠布,每穴按壓10下,誘導時間為30min。后行靜脈全麻,耳穴埋針持續(xù)至術畢。 靶控輸注丙泊酚,以血漿靶濃度1.5ug/L為起點,到達預期血漿靶濃度后每30秒遞增0.3ug/L,直至患者意識消失。將丙泊酚的靶控血藥濃度值調(diào)整為當時儀器顯示的效應室濃度值,并保持此濃度不變。然后靶控輸注瑞芬太尼,以瑞芬太尼血漿濃度2.0ug/L為起點,到達預期血漿靶濃度后每30秒遞增0.3ug/L。直至患者對(壓眶反射)疼痛刺激無體動反應,記錄兩組病人意識、疼痛消失時血藥及效應室濃度、圍術期血流動力學變化及腦電雙頻指數(shù)的變化。 結果： 1.兩組病人性別、年齡、體重、身高差異均無統(tǒng)計學意義 2.與對照組相比,耳針組誘導過程中血流動力學更平穩(wěn)(p0.05),拔管時對照組心率和血壓較高(p0.05) 3.意識消失時,耳針組丙泊酚血漿、效應室濃度明顯低于對照組,差別有統(tǒng)計學意義(p0.05) 4.疼痛反應消失時,耳針組瑞芬太尼血漿、效應室濃度明顯低于對照組,差別有統(tǒng)計學意義(p0.05) 5.耳穴埋針后,耳針組與對照組BIS值分別為87±9、96±1,其差別有統(tǒng)計學意義p0.05),說明BIS與耳穴埋針具有良好的相關性。 6.與對照組相比,耳針組的瑞芬太尼在手術過程中用藥總劑量明顯降低,對照組在手術過程中丙泊酚用藥總劑量變化不明顯。 結論：1.當意識和疼痛消失時,耳針減少了TCI誘導期間丙泊酚瑞芬太尼血漿效應室濃度。 2.圍麻醉期間耳針埋針減少了麻醉全程丙泊酚／瑞芬太尼的總用量。 3.全身麻醉期間,結合血流動力學變化,BIS和病例的麻醉深度相關性良好。
[Abstract]:Objective: to evaluate the auxiliary effect of auricular acupuncture combined with target-controlled infusion on propofol-remifentanil intravenous anesthesia in inguinal hernia surgery. Methods: fifty patients with abdominal external hernia in general surgery were randomly divided into auricular acupuncture group (n = 25) and control group (n = 25). The control group: propofol remifentanil; Liver, subcortical, Shenmen points. The patients were monitored by ECG, blood pressure, pulse oxygen saturation (SPO _ 2) after entering the room. At the same time, the bispectral index of electroencephalogram (BIS) was continuously monitored. In the auricular acupuncture group, the pressure method was used to compress the adhesive cloth attached to the auricular points. The induction time was 30 mins for 10 times per acupoint, followed by intravenous general anesthesia, auricular acupoint embedding needle continued until the end of operation. Target-controlled infusion of propofol, starting with the plasma target concentration of 1.5ug-1 / L, increased by 0.3 ugr / L every 30 seconds after reaching the expected plasma target concentration, until the patient's consciousness disappeared. The target controlled plasma concentration of propofol was adjusted to the effect chamber concentration shown by the instrument at that time. Then the target controlled infusion of remifentanil, starting with remifentanil plasma concentration 2.0ugp / L, increased by 0.3 ugr / L every 30 seconds after the expected plasma concentration was reached, until the patient had no physical response to the pain of (orbital baroreflex). The consciousness, the concentration of blood drug and effector ventricle, the hemodynamic changes and the change of bispectral index of EEG were recorded in the two groups when the pain disappeared. Results:. 1. There was no significant difference in sex, age, weight and height between the two groups. 2.Compared with the control group, the hemodynamics of the auricular acupuncture group was more stable than that of the control group, and the heart rate and blood pressure of the control group were higher than that of the control group during the extubation. 3.When consciousness disappeared, the plasma concentration of propofol in auricular acupuncture group was significantly lower than that in control group (P 0.05). 4.When the pain reaction disappeared, the concentration of remifentanil plasma and effector chamber in auricular acupuncture group was significantly lower than that in control group (P 0.05). 5. The BIS values of auricular acupuncture group and control group were 87 鹵90.96 鹵1, respectively. The difference was statistically significant (p0.05), which indicated that BIS had a good correlation with auricular acupuncture. 6. Compared with the control group, the total dose of remifentanil in the auricular acupuncture group decreased significantly during the operation, while the total dose of propofol did not change significantly in the control group. Conclusion 1. When consciousness and pain disappear, ear acupuncture reduces plasma effector ventricular concentration of propofol remifentanil during TCI induction. 2. The total dosage of propofol / remifentanil was reduced by auricular acupuncture during perianaesthesia. 3. During general anesthesia, there was a good correlation between BIS and depth of anesthesia combined with hemodynamic changes.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

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