本文選題：依托咪酯　切入點：丙泊酚　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：本研究采用隨機、單盲設(shè)計,使用邁瑞無創(chuàng)血流動力學(xué)監(jiān)測系統(tǒng)及BIS監(jiān)測儀監(jiān)測,應(yīng)用丙泊酚、依托咪酯乳劑及兩種藥物以各50%血漿濃度靶控輸注三種方法,觀察高血壓患者全麻誘導(dǎo)期間血流動力學(xué)改變、麻醉深度及不良反應(yīng)的影響,評價這三種誘導(dǎo)方法在高血壓患者中的應(yīng)用價值。 方法：本研究經(jīng)醫(yī)院倫理委員會批準(zhǔn),選取ASA Ⅱ級,有高血壓病史擇期全麻手術(shù)腹腔鏡下膽囊切除術(shù)患者60例,患者術(shù)前均規(guī)律服用降壓藥。隨機分為三組,丙泊酚組(P組),依托咪酯(E組),聯(lián)合組(PE組),每組20例。三組分別采用丙泊酚3ug/ml、依托咪酯0.6ug/ml、丙泊酚聯(lián)合依托咪酯各50%血漿靶控濃度輸注誘導(dǎo)。分別于麻醉誘導(dǎo)前(TO,基礎(chǔ)值)、喉鏡置入前即刻(T1)、插管后即刻(T2)、插管后1min(T3)、5min(T4),觀察患者心率、平均動脈壓、收縮壓、舒張壓、BIS值的變化以及每博輸出量,心指數(shù),外周血管阻力指數(shù)；同時記錄患者有無注射痛、肌肉陣攣等不良反應(yīng)發(fā)生,以及從注藥開始到睫毛反射消失的時間。 結(jié)果：1、一般情況：三組患者身高、體重、年齡、在誘導(dǎo)前(時間點T0)的平均動脈壓、收縮壓、心輸出量、每博輸出量、外周血管阻力指數(shù)和心率均無統(tǒng)計學(xué)意義(P0.05)。 2、三組患者開始靜脈輸注鎮(zhèn)靜催眠藥至眼瞼反射消失時間的比較,PE組眼瞼反射消失時間明顯短于P組和E組(P0.05)。 3、三組患者在麻醉誘導(dǎo)期間血流動力學(xué)變化的比較：①三組患者在麻醉誘導(dǎo)期間心率的比較,P組的心率在喉鏡置入前即刻低于E組與PE組,差異有統(tǒng)計學(xué)意義(P0.05)。E組的心率在插管即刻至插管后(T2-T4)高于P組和PE組(P0.05)。PE組在喉鏡置入前即刻與插管后比較無統(tǒng)計學(xué)差異(P0.05)。②三組患者在麻醉誘導(dǎo)期間的平均動脈壓比較,P組在插管期間和插管后(T1-T4)的平均動脈壓低于E組和PE組(P0.05)。在插管即刻(T2)E組平均動脈壓高于P組和PE組(P0.05)。③三組患者收縮壓的比較,E組在置入喉鏡即刻至插管期間(T1-T4)的收縮壓高于P組和PE組,有統(tǒng)計學(xué)差異(P0.05)。④三組患者舒張壓的比較,P組在置入喉鏡即刻至插管期間(T1-T4)的舒張壓低于E組和PE組,有統(tǒng)計學(xué)差異(P0.05)。PE組在置入喉鏡即刻至插管期間(T1-T4)的舒張壓與E組比較無統(tǒng)計學(xué)差異(P0.05)。⑤三組患者每博輸出量的比較,P組在置入喉鏡即刻至插管期間(T1～T4)的每博輸出量低于E組和PE組,有統(tǒng)計學(xué)差異(P0.05)。PE組在置入喉鏡即刻至插管期間(T1～T4)的每博輸出量(SV)與E組比較無統(tǒng)計學(xué)差異(P0.05)。PE組在喉鏡置入前(T1)與插管時(T2)比較無統(tǒng)計學(xué)差異(P0.05)。⑥三組患者心指數(shù)的比較,P組在喉鏡置入前和插管后(T1～T4)的心指數(shù)低于PE組和E組(P0.05)。PE組心指數(shù)在喉鏡置入前即刻與插管后即刻(T1和T2)與E組比較無統(tǒng)計學(xué)差異(P0.05),與P組比較有統(tǒng)計學(xué)差異(P0.05)。⑦三組患者外周血管阻力指數(shù)的比較,P組在喉鏡置入前和插管后(T1～T4)的外周血管阻力指數(shù)低于PE組和E組(P0.05)。PE組外周血管阻力指數(shù)在喉鏡置入前和插管后(T1～T4)與E組比較無統(tǒng)計學(xué)差異(P0.05),與P組比較有統(tǒng)計學(xué)差異(P0.05)。⑧三組患者循環(huán)波動情況P組的循環(huán)波動發(fā)生例數(shù)高于PE組,有統(tǒng)計學(xué)差異(P0.05)。 4.麻醉深度的比較：三組患者在麻醉誘導(dǎo)期間BIS值的比較,在誘導(dǎo)前、插管期間和插管后(T0～T4)的三組BIS值比較,均無統(tǒng)計學(xué)差異(P0.05)。 5.副作用的比較①三組患者注射痛的發(fā)生率比較,P組注射痛發(fā)生率高于PE組(P0.05)。②三組患者肌陣攣的發(fā)生率比較,P組、PE組肌陣攣發(fā)生率低于E組(P0.05)。 結(jié)論：丙泊酚和依托咪酯乳劑聯(lián)合靶控輸注用于高血壓患者的全麻誘導(dǎo)與單獨使用丙泊酚或依托咪酯乳劑相比,可以獲得相對穩(wěn)定的血流動力學(xué)穩(wěn)定特征,并且減少靜脈麻醉藥注射痛和肌陣攣副作用的發(fā)生率,可以作為高血壓患者全身麻醉誘導(dǎo)的一種較好的麻醉誘導(dǎo)方法。
[Abstract]:Objective: This study used a randomized, single blind design, the use of MINDRAY noninvasive hemodynamic monitoring system and BIS monitoring, the application of propofol, etomidate and two kinds of drugs in the 50% plasma concentration of target controlled infusion of three methods, observed during induction of anesthesia in patients with hypertension and hemodynamic changes, affect the depth of anesthesia and adverse reactions. The application value of the three induction methods of evaluation in patients with hypertension.
Methods: This study was approved by the hospital ethics committee, selected ASA grade II, 60 cases of patients undergoing resection of hypertension undergoing elective surgery under general anesthesia laparoscopic cholecystectomy, the patients were regularly taking antihypertensive drugs. Were randomly divided into three groups: Propofol group (group P), etomidate (E group), combination group (PE group), 20 cases in each group. The three groups were used propofol 3ug/ml 0.6ug/ml, etomidate, propofol etomidate combined the 50% plasma target concentration infusion induced. Respectively before induction of anesthesia (TO, baseline), immediately before laryngoscopy (T1), immediately after intubation (T2), 1min after intubation (T3), 5min (T4), observed in patients with heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, the change of BIS value and stroke volume, cardiac index, peripheral vascular resistance index; there is no injection pain were recorded at the same time, the adverse reaction of muscle clonus occurred, and the time from the injection to the eyelash reflex.
Results: 1, general situation: three groups of patients had no significant difference in height, weight, age, mean arterial pressure, systolic blood pressure, cardiac output, output per hour, peripheral vascular resistance index and heart rate before induction (time T0) (P0.05).
2, three groups of patients to comparison of intravenous infusion of sedatives to eyelid reflex time, PE group the eyelid reflex time was significantly shorter in the P group and E group (P0.05).
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本文編號：1560363