本文關(guān)鍵詞： 右美托咪定 丙泊酚 麻醉誘導(dǎo) 臨床藥效學(xué)　出處：《廣州中醫(yī)藥大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 觀察泵注不同負(fù)荷劑量右美托咪定復(fù)合丙泊酚靶控輸注麻醉誘導(dǎo)期間對(duì)患者睫毛反射消失、意識(shí)消失及血流動(dòng)力學(xué)變化的影響,探討丙泊酚麻醉誘導(dǎo)時(shí)右美托咪定的適宜輸注負(fù)荷劑量,以及右美托咪定與丙泊酚鎮(zhèn)靜催眠效應(yīng)相互作用。方法： (一)右美托咪定聯(lián)合丙泊酚麻醉誘導(dǎo)時(shí)適宜負(fù)荷劑量的探討 選擇ASA Ⅰ～Ⅱ級(jí)擇期手術(shù)患者60例(男女各30例),隨機(jī)分為5組(n=12)：生理鹽水對(duì)照組(C組),右美托咪定025μg·kg-1、0.50μg·kg-1、0.75μg·kg-1、1.00μg·kg-14組(D1-4組)。各組使用Graseby3500泵將右美托咪定負(fù)荷劑量于10min內(nèi)泵注完畢,后丙泊酚靶控輸注(TCI)泵入,初始靶濃度設(shè)定為1.0μg.mL-,每次增加05μg·mL-1,直至患者意識(shí)消失。記錄入室(T0)、給藥后5min (T1)、10min (T2)、睫毛反射消失時(shí)(T3)、意識(shí)消失時(shí)(T4)、插管前即可(T5)、氣管插管后1min (T6)、3min (T7)時(shí)的心率(HR)、平均動(dòng)脈壓(MAP)值、脈搏血氧飽和度(SpO2)。記錄睫毛反射消失時(shí)(T3)、意識(shí)消失時(shí)(T4)丙泊酚效應(yīng)室濃度(Pce)及劑量(P)。 (二)不同劑量右美托咪定對(duì)丙泊酚全麻誘導(dǎo)期間鎮(zhèn)靜深度的影響 ASA分級(jí)Ⅰ～Ⅱ級(jí),擇期全麻手術(shù)患者60例(男28例,女32例),隨機(jī)分為5組(n=12)：生理鹽水對(duì)照組(C組),右美托咪定025μg·kg-1、0.50μg·kg-1、0.75μg·kg-1、1.0μg·kg-14組(D1-4組)。各組使用Graseby3500泵將右美托咪定負(fù)荷劑量于10min內(nèi)泵注完畢,給藥后每3min行警覺(jué)-鎮(zhèn)靜(OAA/S)評(píng)分一次,并記錄BIS值。麻醉誘導(dǎo)直接啟動(dòng)丙泊酚TCI,初始靶濃度設(shè)定為10μg·mL-1,根據(jù)OAA/S評(píng)分和BIS值調(diào)整靶濃度,每次增加05μg·mL-1,直到患者OAA/S評(píng)分達(dá)1分。記錄給藥前(T0)給藥后3min (T1)、6min (T2)、9min(T3)、OAA/S評(píng)分1分時(shí)(T4)、插管前(T5)、插管結(jié)束后1min (T6)、3min (T7)各時(shí)刻的BIS值、心率(HR)、平均動(dòng)脈壓(MAP)值。結(jié)果： (一)右美托咪定聯(lián)合丙泊酚麻醉誘導(dǎo)時(shí)適宜負(fù)荷劑量的探討：與基礎(chǔ)值比較,D1組HR、MAP在T6、T7時(shí)間點(diǎn)顯著升高(P0.05)；D2組、D3組HR、MAP在T1-T5降低(P0.05)；D4組HR在各時(shí)間點(diǎn)均降低(P0.05),MAP在T2、T3時(shí)間點(diǎn)顯著升高(P0.05)。D2組、D3組、D4組在T3、T4時(shí)丙泊酚效應(yīng)室濃度(Pce)及用量(P)比C組、D1組明顯降低(P0.05)。麻醉誘導(dǎo)期間D4組出現(xiàn)心動(dòng)過(guò)緩的發(fā)生率明顯多于其他各組。 (二)不同劑量右美托咪定對(duì)丙泊酚全麻誘導(dǎo)期間鎮(zhèn)靜深度的影響：給予右美托咪定負(fù)荷劑量后,D2組、D3組、D4組患者BIS值較C組、D1組下降明顯(P0.05)；插管后C組、D1組患者BIS較插管前(T5)明顯升高(P0.05)。與T0比較,C組、D1組HR, MAP在T6、T7時(shí)間點(diǎn)顯著升高(P0.05)；D2組HR、MAP在T2-T5降低(P0.05)；D3組、D4組HR在T1-T5時(shí)間點(diǎn)均降低(P0.05),MAP在T2-T4時(shí)間點(diǎn)顯著升高(P0.05)。BIS與OAA/S評(píng)分等級(jí)相關(guān)性顯著。結(jié)論： (一)右美托咪定負(fù)荷劑量0.50～0.75μg·kg-1復(fù)合丙泊酚全麻誘導(dǎo)期間血流動(dòng)力學(xué)平穩(wěn)。右美托咪定可降低丙泊酚效應(yīng)室濃度和用量,當(dāng)劑量0.75μg·kg-1具有封頂效應(yīng),在負(fù)荷劑量0～1.00μg·kg-1范圍內(nèi)呈線性相關(guān)性。 (二)右美托咪定可降低患者BIS值,增強(qiáng)丙泊酚鎮(zhèn)靜效應(yīng),在負(fù)荷劑量0-1.00μg·kg-1范圍內(nèi)隨著劑量增大,其鎮(zhèn)靜效應(yīng)越強(qiáng),但劑量再增加對(duì)丙泊酚鎮(zhèn)靜作用無(wú)明顯影響。
[Abstract]:Purpose : To observe the effects of propofol on the disappearance of eyelash reflex , disappearance of consciousness and hemodynamics in patients with propofol target controlled infusion at different loading doses . A study on the optimal loading dose at induction of propofol combined with propofol Sixty patients ( 30 male and female ) were randomly divided into 5 groups ( n = 12 ) : normal saline control group ( group C ) , dextrazine 025 渭g 路 kg -1 , 0.50 渭g 路 kg -1 , 0.75 渭g 路 kg -1 , 1.00 渭g 路 kg - 14 group ( D1 - 4 group ) . ( 2 ) Effects of different doses of dexlansoprazole on sedation depth during induction of propofol in general anesthesia All groups were randomly divided into 5 groups ( n = 12 ) : normal saline control group ( group C ) , dextrazine 025 渭g 路 kg -1 , 0.50 渭g 路 kg -1 , 0.75渭g 路 kg -1 , 1.0渭g 路 kg - 14 group ( D1 - 4 group ) . In group D and D3 , the concentration of propofol ( Pce ) and the dosage ( P ) in group D , D3 and D4 were significantly higher than those in group C and D1 ( P0.05 ) . In group C and D1 , HR and MAP increased significantly in group C and D1 ( P0.05 ) . The HR and MAP in group D were significantly higher than those in group D ( P0.05 ) . ( 1 ) The hemodynamics was stable during the induction of propofol anesthesia induction at 0.50 - 0.75 渭g 路 kg - 1 . The concentration and dosage of propofol in propofol could be decreased . When dose 0.75 渭g 路 kg - 1 had capping effect , linear correlation was found in the range of 0 锝，

本文編號(hào)：1513812