本文關(guān)鍵詞： 蘇醒期躁動(dòng) 褪黑素 老年 胃癌手術(shù)　出處：《安徽醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：比較氣管內(nèi)全麻或硬膜外復(fù)合全麻這兩種不同麻醉方式對(duì)老年胃癌手術(shù)患者血漿褪黑素濃度影響及其與蘇醒期躁動(dòng)關(guān)系。 方法：50例老年胃癌患者隨機(jī)均分成兩組，T組為氣管內(nèi)全麻組，ET組為硬膜外復(fù)合全麻組。ET組患者選擇T8-9間隙給予硬膜外穿刺，，操作成功后分次給予1%利多卡因+0.25%羅哌卡因混合液，總量約10-15ml，于硬膜外停止給藥后15min測定阻滯平面再行全麻誘導(dǎo)。兩組患者全麻誘導(dǎo)依次給予咪達(dá)唑侖0.04mg/kg、依托咪酯0.2-0.3mg/kg、芬太尼3-4μg/kg、羅庫溴銨0.6-0.8mg/kg，待BIS值達(dá)到40行氣管插管，后連接麻醉機(jī)行機(jī)械通氣，術(shù)中維持PetCO2為35-45mmHg，BIS值在40-50。術(shù)中靜脈持續(xù)泵人丙泊酚2-6mg/kg·h，瑞芬太尼6-10μg/kg·h維持麻醉，ET組患者每隔1h左右硬膜外給藥，術(shù)中按需靜注順阿曲庫銨0.05-0.1mg/kg，手術(shù)期間維持患者血壓在基礎(chǔ)血壓的正負(fù)20%，術(shù)中若出現(xiàn)血壓過高或過低，適當(dāng)給予血管活性藥物（尼卡地平或麻黃素），若心率＜50次/分，持續(xù)1min未緩解者靜注阿托品0.5mg治療。手術(shù)結(jié)束后，待患者自主呼吸恢復(fù)，SpO2維持在95%以上，意識(shí)清醒，拔出氣管內(nèi)導(dǎo)管。ET組患者術(shù)畢拔除硬膜外導(dǎo)管，兩組患者術(shù)畢清醒拔管后均接電子鎮(zhèn)痛泵，持續(xù)至術(shù)后2天。麻醉恢復(fù)期對(duì)患者進(jìn)行躁動(dòng)評(píng)分并記錄，采集麻醉前（T0）、手術(shù)結(jié)束（T1）2個(gè)時(shí)點(diǎn)的中心靜脈血測定血漿褪黑素濃度。本實(shí)驗(yàn)為排除手術(shù)過程中光線對(duì)褪黑素分泌的抑制作用,均在誘導(dǎo)麻醉后對(duì)患者頭部施以包裹處理,術(shù)前均以利多卡因乳膏潤滑導(dǎo)尿管為減輕術(shù)后因?qū)蚬艽碳ひ鸩∪说男g(shù)后煩躁。結(jié)果:與T組比較,ET組患者術(shù)后躁動(dòng)評(píng)分明顯降低（P0.01）,術(shù)畢患者血漿褪黑素濃度明顯增高（P0.01）;在T或ET這兩種不同麻醉方式下，患者蘇醒期躁動(dòng)評(píng)分與術(shù)畢褪黑素濃度有相關(guān)（r=-0.429，P0.05）。 結(jié)論：老年胃癌患者在ET麻醉方式下，可減少蘇醒期躁動(dòng)的發(fā)生，且與術(shù)畢血漿褪黑素濃度呈負(fù)相關(guān)。
[Abstract]:Aim: to compare the effect of general anesthesia or epidural general anesthesia on plasma melatonin concentration in elderly patients with gastric cancer and its relationship with restlessness during recovery. Methods 50 elderly patients with gastric cancer were randomly divided into two groups: group T: endotracheal general anesthesia group (group et), group et: combined epidural general anesthesia group. Group et selected the T8-9 space for epidural puncture. After successful operation, 1% lidocaine and 0.25% ropivacaine were given separately. The total amount was about 10-15 ml. After the epidural administration was stopped, the block level was measured and induced by general anesthesia. The patients in the two groups were given midazolam 0.04 mg / kg, etomidate 0.2-0.3 mg / kg, fentanyl 3-4 渭 g / kg, rocuronium 0.6-0.8 mg / kg, and the BIS was 40 lines tracheal intubation. The maintenance PetCO2 was 35-45 mmHg BIS between 40 and 50. Intravenous infusion of propofol 2-6 mg / kg 路h and remifentanil 6-10 渭 g / kg 路h were administered every 1 hour or so. Intraoperative intravenous injection of cisatracurium 0.05-0.1 mg / kg was performed during the operation to maintain the positive or negative basic blood pressure of the patient. If the blood pressure was too high or too low during the operation, appropriate vasoactive drugs (nicardipine or ephedrine, heart rate < 50 / min) were given. After the operation, SPO _ 2 was maintained above 95%, conscious, and the patients in the et group were removed the epidural catheter after the operation, and the patients in the endotracheal catheter group were removed after the operation, and the patients in the control group were treated with atropine 0.5 mg. The patients in both groups were treated with electronic analgesia pump after the operation. The restlessness score was recorded during the recovery period of anesthesia. The concentration of plasma melatonin was measured in central venous blood at two time points before anesthesia and at the end of operation. In order to exclude the inhibitory effect of light on the secretion of melatonin during operation, the patients' head was treated with encapsulation after induction of anesthesia. Results: compared with group T, the postoperative restlessness score of patients in et group was significantly lower than that in group T, and the plasma melatonin concentration in patients at the end of operation was significantly lower than that in group T. It was significantly higher than that of P0.01T or et under two different anesthetic methods, The restlessness score was correlated with melatonin concentration at the end of operation. Conclusion: the elderly patients with gastric cancer can reduce restlessness in the recovery period under et anesthesia, and have a negative correlation with the plasma melatonin concentration at the end of operation.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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