本文關(guān)鍵詞： 長(zhǎng)期過量飲酒 舒芬太尼 劑量效應(yīng)關(guān)系 氣管插管　出處：《福建醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：擬通過測(cè)定長(zhǎng)期過量飲酒對(duì)舒芬太尼抑制氣管插管時(shí)心血管反應(yīng)ED50的影響，從而評(píng)價(jià)長(zhǎng)期過量飲酒對(duì)舒芬太尼效力的影響。 方法:擇期擬行全麻手術(shù)的成年男性患者，BMI18~25kg/m2,年齡25~55歲，ASA分級(jí)Ⅰ~Ⅱ級(jí)納入本研究。根據(jù)世界衛(wèi)生組織(WHO)對(duì)長(zhǎng)期過量飲酒的定義將手術(shù)患者分為長(zhǎng)期過量飲酒組（D組，n=19）和非飲酒組（N組，，n=22）。D組和N組分別先靜脈注射丙泊酚2.0~3.0mg/kg(45s),維持腦狀態(tài)指數(shù)(CSI)值40~55,繼而靜脈注射順阿曲庫(kù)銨0.2mg/kg，按預(yù)設(shè)劑量靜注舒芬太尼,5min后行氣管插管。監(jiān)測(cè)麻醉誘導(dǎo)前(T0基礎(chǔ)值)，插管前即刻(T1)，插管后1min(T2)，插管后5min(T3)血壓心率和CSI的變化。按改良序貫法，舒芬太尼的第一個(gè)劑量是預(yù)實(shí)驗(yàn)中出現(xiàn)陰性反應(yīng)的劑量，D組和N組初始舒芬太尼劑量分別為0.5ug/kg和0.4ug/kg，若患者反應(yīng)為陽性（氣管插管后MAP或HR超過基礎(chǔ)值的15％），則下一例舒芬太尼劑量上調(diào)0.1ug/kg，若患者反應(yīng)為陰性（氣管插管后MAP或HR未超過基礎(chǔ)值的15％），則下一例舒芬太尼劑量下調(diào)0.1ug/kg，重復(fù)此過程直至出現(xiàn)6次陰性－陽性轉(zhuǎn)折停止研究。采用序貫法計(jì)算舒芬太尼ED50及其95％可信區(qū)間CI。 結(jié)果：D組和N組在年齡、體重指數(shù)、性別構(gòu)成均無統(tǒng)計(jì)學(xué)差異（P0.05），兩組麻醉誘導(dǎo)前心率、收縮壓、舒張壓、CSI亦無顯著性差異。D組納入患者均為長(zhǎng)期過量飲酒者，均未發(fā)現(xiàn)有酒精性疾病及其合并癥。D組及N組舒芬太尼抑制氣管插管時(shí)心血管反應(yīng)的ED50及其95％可信區(qū)間分別為0.41(0.37，0.47)ug/kg和0.30(0.27，0.34)ug/kg，D組ED50高于N組(P0.05)。 結(jié)論：長(zhǎng)期過量飲酒可增加氣管插管時(shí)舒芬太尼抑制心血管反應(yīng)ED50，提示長(zhǎng)期過量飲酒降低舒芬太尼抑制應(yīng)激反應(yīng)的效力。
[Abstract]:Aim: to evaluate the effect of long-term excessive drinking on the efficacy of sufentanil by measuring the effect of sufentanil on cardiovascular response (ED50) to tracheal intubation. Methods: adult male patients undergoing elective general anesthesia were divided into long-term excessive drinking group according to the World Health Organization (WHO) definition of long-term excessive drinking. Group D and group N were given intravenous injection of propofol 2.0 mg / kg / kg for 45sd respectively, and then intravenous injection of atracurium 0.2 mg / kg / kg for 5 min. The anesthesia was monitored by endotracheal intubation after 5 minutes of intravenous injection of sufentanil (0.2mg 路kg ~ (-1)) in group D (n = 10) and non-drinking group (n = 10), and then administered intravenously by intravenous injection of sufentanil (0.2mg / kg) to monitor anesthesia after 5 minutes of intravenous injection of propofol (2.0 mg / kg 路kg ~ (-1)). The changes of blood pressure and heart rate and CSI were observed immediately before intubation, 1 min after intubation, 5 min after intubation, and 5 min after intubation. The first dose of sufentanil was the initial dose of sufentanil in group D and group N, which were negative in the pretest. If the patient was positive (MAP or HR exceeded 15% of the base value after tracheal intubation), the next one was the first dose of sufentanil in group D and group N, respectively. The dose of sufentanil was increased by 0.1ug-kg. if the patient's response was negative (MAP or HR was not more than 15% of the base value after tracheal intubation), then the next case of sufentanil was down-regulated by 0.1 ug-kg-1 / kg, and repeated this process until six negative-positive turning points stopped the study. Sequential method was used to calculate sufentanil ED50 and its 95% CI. Results there was no significant difference in age, body mass index and sex composition between group D and group N. there was no significant difference in heart rate, systolic blood pressure, diastolic blood pressure and CSI between two groups before anesthesia induction. The ED50 and 95% confidence intervals of sufentanil in group D and group N for inhibiting cardiovascular response to endotracheal intubation were 0.41 ~ 0.37 渭 r / kg and 0.30 ~ 0.27 ~ 0.34 g / kg respectively. The ED50 of group D was higher than that of group N (P 0.05). Conclusion: Long-term excessive drinking can increase the inhibitory effect of sufentanil on cardiovascular response ED50 during tracheal intubation, suggesting that long-term excessive drinking reduces the inhibitory effect of sufentanil on stress response.
【學(xué)位授予單位】：福建醫(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

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 孫永鋒;馮春;婁曄;;腦功能狀態(tài)指數(shù)(CSI)在全麻中作為鎮(zhèn)痛深度監(jiān)測(cè)的實(shí)驗(yàn)研究[J];當(dāng)代醫(yī)學(xué);2010年21期

2 郭田生，田群力;酒依賴與內(nèi)源性阿片系統(tǒng)[J];國(guó)外醫(yī)學(xué).精神病學(xué)分冊(cè);1996年03期

3 方為;侯俊;林雷;余相地;湯和青;;經(jīng)鼻纖維支氣管鏡氣管插管時(shí)舒芬太尼ED_(50)[J];臨床麻醉學(xué)雜志;2013年10期

4 鄭宏;華玉思;朱素潔;鄒田田;楊龍;宣燕;;手術(shù)患者術(shù)前飲酒與健康狀況的流行病學(xué)調(diào)查[J];中國(guó)全科醫(yī)學(xué);2011年14期

5 楊泉涌;薛富善;許亞超;劉毅;廖旭;張雁鳴;劉建華;;等效小劑量瑞芬太尼和芬太尼對(duì)經(jīng)口氣管插管小兒血流動(dòng)力學(xué)反應(yīng)的比較[J];實(shí)用兒科臨床雜志;2008年23期

6 李秀敏,鄧源;乙醇的中樞神經(jīng)系統(tǒng)損傷作用[J];中國(guó)臨床康復(fù);2005年21期

7 馬冠生,朱丹紅,胡小琪,欒德春,孔靈芝,楊曉光;中國(guó)居民飲酒行為現(xiàn)況[J];營(yíng)養(yǎng)學(xué)報(bào);2005年05期

8 ;Different alterations of cytochrome P450 3A4 isoform and its gene expression in livers of patients with chronic liver diseases[J];World Journal of Gastroenterology;2003年02期

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