發(fā)布時(shí)間：2018-03-02 01:09

  本文關(guān)鍵詞： 右美托咪定 丙泊酚 內(nèi)鏡 食管靜脈曲張?zhí)自g(shù) 哌替啶　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：比較右美托咪定或丙泊酚復(fù)合芬太尼用于內(nèi)鏡下食管靜脈曲張?zhí)自g(shù)（EVL）的安全性和有效性。 方法：選擇擇期行內(nèi)鏡下食管靜脈曲張?zhí)自g(shù)的患者60例，隨機(jī)均分為A、B、C3組，分別為哌替啶組（A），丙泊酚組（B），右美托咪定組（C）。三組性別、年齡、體重、食管靜脈曲張形態(tài)、Child-Pugh分級(jí)差異無顯著性（P0.05)。所有患者術(shù)前禁食8h，禁飲6h，未使用術(shù)前藥。入室前用2%利多卡因?qū)谇患把屎聿窟M(jìn)行充分表面麻醉。入室后取左側(cè)臥位，鼻導(dǎo)管吸氧（氧流量5L/min），監(jiān)測(cè)心電圖、血壓、脈搏血氧飽和度。A組肌注哌替啶50mg15min后進(jìn)行手術(shù)；B組靜注芬太尼1.0μg/kg后，1.5mg/kg丙泊酚3min恒速誘導(dǎo)后進(jìn)鏡手術(shù)，術(shù)中以“9-7-5”恒速輸注方案維持麻醉，手術(shù)結(jié)束時(shí)停藥；C組靜注芬太尼1.0μg/kg后，1.5μg/kg右美托咪定，10min靜脈泵注后進(jìn)行操作。所有手術(shù)均由同一名有豐富經(jīng)驗(yàn)的內(nèi)鏡醫(yī)生完成。術(shù)畢患者恢復(fù)至Ramsay評(píng)分2-3分時(shí)記為麻醉結(jié)束，轉(zhuǎn)運(yùn)至觀察室。記錄患者血壓、心率、脈搏氧飽和度，Ramsay鎮(zhèn)靜評(píng)分，，內(nèi)鏡操作和麻醉時(shí)間以及術(shù)中、術(shù)后不良反應(yīng)：?jiǎn)芸取盒�、躁�?dòng)、心動(dòng)過緩、低血壓、高血壓和低氧血癥。術(shù)后24小時(shí)隨訪，記錄患者術(shù)中知曉情況及滿意度（NRS，0-10），內(nèi)鏡醫(yī)生滿意度（NRS,0-10）。 結(jié)果：3組患者均順利完成手術(shù)。3組患者一般資料比較差異無統(tǒng)計(jì)學(xué)意義（P0.05）。B、C兩組術(shù)中Ramsay評(píng)分分別為（5.2±0.3）、（3.5±0.4），顯著高于A組（1.6±0.4）（P0.05）。給藥后初期B組心率、血壓下降顯著（P0.05），進(jìn)境后A組心率、血壓明顯升高(P0.05)，C組循環(huán)較穩(wěn)定。C組術(shù)中低氧血癥發(fā)生率明顯低于B組（P0.05）。B、C兩組均未發(fā)生嗆咳、惡心、躁動(dòng)或高血壓，A組發(fā)生率分別為40%、60%、40%和30%，顯著高于B、C兩組（P0.05）。B、C兩組內(nèi)鏡醫(yī)生滿意度（9.2±0.3）和（9.6±0.4）顯著高于A組（5.0±0.4）（P0.05），B、C兩組患者滿意度（9.6±0.3）和（9.6±0.4）顯著高于A組（5.4±0.3）（P0.05）。三組內(nèi)鏡操作時(shí)間無差異,麻醉時(shí)間B（35±4）、C(36±5)兩組明顯少于A組(44±6)（P0.05）。B、C兩組麻醉時(shí)間、醫(yī)患滿意度無差異，C組心動(dòng)過緩（5%）、低血壓（0）、低氧血癥（0）發(fā)生率顯著低于B組（分別是40%、30%和30%）（P0.05）。術(shù)后隨訪B、C組患者無術(shù)中知曉。 結(jié)論：右美托咪定或丙泊酚復(fù)合芬太尼用于EVL鎮(zhèn)靜鎮(zhèn)痛效果均優(yōu)于哌替啶基礎(chǔ)麻醉，且應(yīng)用右美托咪定時(shí)血流動(dòng)力學(xué)及呼吸較丙泊酚更穩(wěn)定，并可根據(jù)手術(shù)需要及時(shí)喚醒患者配合內(nèi)鏡操作。
[Abstract]:Aim: to compare the safety and efficacy of dexmetomidine or propofol combined with fentanyl in endoscopic esophageal variceal ligation (EVLL). Methods: sixty patients undergoing endoscopic esophageal varicose ligation were randomly divided into three groups: pethidine group, propofol group, dexmetomidine group, sex, age, body weight. There was no significant difference in Child-Pugh grade of esophageal varices (P 0.05). All patients were fasting for 8 hours before operation, and no drugs were used for 6 hours. 2% lidocaine was used to anesthetize the oral cavity and throat before entering the room. Nasal catheter oxygen inhalation (oxygen flow rate 5L / min), monitoring ECG, blood pressure, pulse oxygen saturation. Group A was intramuscularly injected pethidine for 15 minutes. Group B received intravenous fentanyl 1.0 渭 g / kg and propofol 1.5 mg / kg for 3 min. The anesthesia was maintained by "9-7-5" constant velocity infusion during the operation. At the end of the operation, fentanyl 1.0 渭 g / kg was injected intravenously in group C and 1.5 渭 g / kg dexmetidine was injected intravenously for 10 minutes. All the operations were performed by the same endoscopic doctor with rich experience. The patients recovered to Ramsay score 2-3 minutes after operation and recorded as the end of anesthesia. The patient's blood pressure, heart rate, pulse oxygen saturation and Ramsay sedation score, endoscopic operation and anaesthesia time, and postoperative adverse reactions: cough, nausea, restlessness, bradycardia, hypotension, Hypertension and hypoxemia were followed up 24 hours after operation to record the patients' intraoperative knowledge and satisfaction with NRSs 0-10, and endoscopers' satisfaction with NRSs 0-10. Results there was no significant difference in the general data of the patients in the three groups who completed the operation successfully. The intraoperative Ramsay scores of the two groups were significantly higher than those of group A (P < 5.2 鹵0.3), respectively, which were significantly higher than those in group A (1.6 鹵0.4), the heart rate and blood pressure in group B decreased significantly (P 0.05) at the beginning of administration, and the heart rate in group A after entering the country was significantly lower than that in group A, which was significantly higher than that in group A (P < 0.05). The incidence of hypoxemia in group C was significantly lower than that in group B (P 0.05). The incidence of restlessness or hypertension in group A was 40% and 30%, respectively, which was significantly higher than that in group B C (P 0.05 鹵0.3) and in group C (P 0.05 鹵0.3) and in group C (9.6 鹵0.4), respectively, which was significantly higher than that in group A (5.0 鹵0.4) and group B (9.6 鹵0.3) and 9.6 鹵0.4), respectively, and was significantly higher than that in group A (5.4 鹵0.35). There was no significant difference in endoscopic operating time among the three groups. The anaesthesia time of group B was significantly less than that of group A (n = 35 鹵4), and the time of anesthesia in group A was significantly less than that in group A (n = 44 鹵6) P 0.05n. There was no difference in patient satisfaction. The incidence of bradycardia, hypotension and hypoxemia in group C was significantly lower than that in group B (4030% and 30%, respectively). No intraoperative knowledge was found in patients in group B and C after operation. Conclusion: the sedative and analgesic effects of dexmetomidine or propofol combined with fentanyl are better than those of pethidine basic anesthesia, and the timing hemodynamics and respiration of dexmetomide are more stable than that of propofol. According to the need of operation, the patient can wake up in time and cooperate with endoscopic operation.
【學(xué)位授予單位】：吉林大學(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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