本文關(guān)鍵詞： 右美托咪定 冠心病 全身麻醉 腰椎手術(shù) 俯臥位　出處：《山東醫(yī)藥》2017年42期 　論文類型：期刊論文

【摘要】：目的觀察右美托咪定對全麻俯臥位行腰椎手術(shù)的冠心病患者圍術(shù)期血流動力學(xué)與麻醉并發(fā)癥的影響。方法選擇全麻俯臥位下行腰椎間盤切除術(shù)的冠心病患者80例,將患者隨機分成觀察組40例和對照組40例。觀察組于麻醉誘導(dǎo)前靜脈輸注右美托咪定0.5μg/kg,輸注時間15 min,繼之以0.2μg/(kg·h)維持至術(shù)畢;對照組輸注等量生理鹽水。術(shù)中維持BIS值40~50。記錄患者基礎(chǔ)值(T_0)、麻醉誘導(dǎo)前即刻(T_1)、氣管插管后即刻(T_2)、俯臥位后即刻(T_3)、俯臥位后30 min(T_4)、俯臥位后1 h(T_5)、手術(shù)結(jié)束(T_6)及平臥位后即刻(T_7)的收縮壓(SBP)、舒張壓(DBP)、心率(HR)、中心靜脈壓(CVP)、心輸出量(CO)、每搏輸出量(SV)和中心靜脈血氧飽和度(SCVO2),術(shù)中心血管不良事件的發(fā)生情況和血管活性藥物的使用情況,蘇醒期和術(shù)后48 h內(nèi)麻醉并發(fā)癥的發(fā)生情況,統(tǒng)計患者的住院時間和術(shù)后28 d死亡情況。結(jié)果與對照組比較,觀察組心動過緩的發(fā)生率增加,心肌缺血和心動過速的發(fā)生率降低;阿托品的平均每例用藥次數(shù)和每次平均用藥劑量增加,艾司洛爾的平均每例用藥次數(shù)減少,去氧腎上腺素的每次平均用藥劑量增加(P均0.05)。與T_0時比較,兩組T_3時SBP、DBP、HR、CO、SV下降,T_2~T_7時HR下降,T_1,T_2,T_4~T_7時CVP增加(P均0.05)。與T_2時比較,對照組T_3時SBP、CVP、CO和SV下降,觀察組T_3時CVP、CO和SV下降(P均0.05)。與T_3時比較,對照組T_4、T_6、T_7時SBP上升,T_4、T_6時DBP上升,T_4~T_7時CVP、CO和SV上升;觀察組T_4~T_7時CVP、CO和SV上升(P均0.05);與對照組比較,觀察組T_2~T_7時HR下降(P均0.05)。與對照組比較,觀察組蘇醒期躁動、刀口疼痛、心動過速和高血壓的發(fā)生率降低(P均0.05),術(shù)后48 h內(nèi)術(shù)后譫妄、刀口疼痛、惡心嘔吐的發(fā)生率降低(P均0.05);兩組術(shù)后28 d均無死亡病例。結(jié)論右美托咪定可增加冠心病患者全麻俯臥位期間血流動力學(xué)的穩(wěn)定性,降低蘇醒期和術(shù)后麻醉并發(fā)癥的發(fā)生率,使蘇醒過程更加平穩(wěn),更有利于患者術(shù)后的康復(fù)。
[Abstract]:Objective to observe the effect of dexmetomidine on perioperative hemodynamics and anesthetic complications in patients with coronary heart disease undergoing lumbar spine surgery in prone position of general anesthesia. Methods 80 patients with coronary heart disease underwent lumbar discectomy in prone position of general anesthesia were selected. The patients were randomly divided into the observation group (n = 40) and the control group (n = 40). Before anesthesia induction, dexmetidine 0.5 渭 g / kg was injected intravenously for 15 min, followed by 0.2 渭 g / kg 路h). The control group was infused with the same amount of normal saline. During the operation, the BIS value was maintained at 40: 50. The patient's basic value was recorded. Immediately before induction of anesthesia, T1 was added. Immediately after tracheal intubation, T 2 was added. Immediately after the intubation, T3 was added, 30 min after the prone position, 30 min after the prone position, 1 h after the prone position, 1 h after the supine position, 1 h after the operation, T6) and supine. Immediately after operation, SBP, DBP, HRD, CVP, COC, SVV) and SCVO2, the incidence of adverse cardiovascular events and the use of vasoactive drugs were observed in patients with acute acute respiratory syndrome (SBP), diastolic blood pressure (DBP), heart rate (HRV), central venous pressure (CVP), cardiac output (COG), and central venous oxygen saturation (SCVO2), and the incidence of adverse cardiovascular events and the use of vasoactive drugs. The incidence of anesthetic complications during the recovery period and 48 hours after operation, the duration of hospitalization and the death rate of 28 days after operation were counted. Results compared with the control group, the incidence of bradycardia in the observation group was higher than that in the control group. The incidence of myocardial ischemia and tachycardia decreased, the average number and dosage of atropine per case increased, and that of esmolol decreased. The average dose of norepinephrine increased by 0.05g / time. Compared with T _ (0), the CVP of two groups decreased at T _ (3) and T _ (3) and T _ (2) / T _ (7). Compared with T _ (2), the CVP increased at T _ (1) T _ (2) T _ (2) T _ (4) T _ (7) and decreased (P < 0.05) at T _ (3) in comparison with T _ (2), and decreased in control group (T _ 3) at T _ 3 and T _ (3), and decreased at T _ (2) T _ (7). In the observation group, the levels of CVPCO and SV in the observation group were 0.05% at T _ 3. Compared with T _ S _ 3, the SBP in the control group increased at T _ 4 / T _ 6 / T _ 7 / T _ 7 / T _ 4 / T _ 6, the CVP / CO and SV increased at T _ 4T _ 7 / T _ 7 in the observation group and 0.05 / d at T _ 4T _ 7 / T _ 7 respectively, respectively, and compared with those in the control group. Compared with the control group, the incidences of restlessness, knife edge pain, tachycardia and hypertension in the observation group were lower than those in the control group, and the incidence of postoperative delirium and knife edge pain within 48 hours after operation were lower in the observation group than in the control group. The incidence of nausea and vomiting decreased by 0.05 and there were no death cases in both groups on the 28th day after operation. Conclusion dexmetomidine can increase hemodynamic stability and decrease the incidence of anaesthesia complications in patients with coronary heart disease during general anesthesia prone position. To make the recovery process more stable, more conducive to postoperative rehabilitation of patients.
【作者單位】： 山東大學(xué)第二醫(yī)院;
【分類號】：R614.2
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本文編號：1522991