本文選題：全麻　切入點：光電容積脈搏波　出處：《石河子大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的:觀察不同劑量芬太尼誘導時患者指端光電容積脈搏波的變化,評價指端光電容積脈搏波監(jiān)測全麻誘導期傷害性應激反應的可行性和準確性。方法:擇期全身麻醉下行手術、ASA分級I~II級、18~60歲的患者90人,患者入室平靜10min后開始誘導,按誘導順序應用咪達唑侖注射液0.05mg/kg,丙泊酚注射1.5mg/kg,當患者意識喪失,靜脈推注順阿曲庫銨0.2mg/kg,根據麻醉誘導期芬太尼的用量隨機分為三組(n=30):F4組芬太尼的劑量為4ug/kg;F5組芬太尼的劑量為5ug/kg;F6組芬太尼的劑量為6ug/kg,肌松完全后行氣管插管,給予機械通氣。分別于入室時(T1)、誘導后2min(T2)、插管即刻(氣管插入聲門10秒后)(T3)、插管后1min(T4)及插管后5min(T5)連續(xù)監(jiān)測并記錄患者心率(Heart rate,HR)、收縮壓(Systolic blood pressure,SBP)、舒張壓(Diastolic blood pressure,DBP)、血氧飽和度(SPO2)、手指溫度、灌注指數(perfusion index,PI)和指端光電容積脈搏波并測量各項參數:指端光電容積脈搏波振幅(Photoplethysmograph pulse wave amplitude,PPGA),前傾角(α1),后傾角(α2),上升時間(t1),下降時間(t2)和脈動周期(Pulse beat interval,PBI),并在同時抽取肘靜脈血4ml,用以測定血漿腎上腺素(epinephrine,E)及去甲腎上腺素(norepinephrine,NE)濃度。結果:與T1時刻相比,T2和T5時刻3組PPGA及PI升高,E和NE減小(P0.05),T3時刻F4組和F5組PPGA及PI降低,α2和NE升高(P0.01),F4組E升高(P0.05),F5組E無明顯變化(P0.05)。F6組于T2、T3、T4和T5時刻PPGA和PI均升高,E和NE均減小(P0.01)。與T3時刻相比,T4和T5時刻F4組和F5組PPGA和PI增高,α2、E和NE降低(P0.05),F6組各指標均無明顯變化(P0.05)。T1時刻各組之間各指標均無統(tǒng)計學意義(P0.05),T3和T4時刻F6組PPGA及PI明顯高于F4組和F5組(P0.01),NE及E水平明顯小于F4組和F5組(P0.01)。PPGA分別與E、NE呈負相關(P0.05),PI分別與HR、SBP、DBP、E、NE呈負相關(P0.05),α2分別與HR、SBP、DBP、NE呈正相關(P0.05),t2分別與HR、SBP、DBP、E、NE呈負相關(P0.05),PBI分別與HR、SBP、DBP、E、NE呈負關(P0.05)。結論:光電容積脈搏波參數PPGA、PI及α2可以無創(chuàng)、實時、有效的監(jiān)測全身麻醉患者的傷害性應激反應,對指導臨床麻醉用藥有一定意義。
[Abstract]:Objective: to observe the changes of photovolumic pulse wave at the fingertip of patients induced by different doses of fentanyl. To evaluate the feasibility and accuracy of finger photovolumic pulse wave monitoring nociceptive stress response during induction of general anesthesia. Methods: 90 patients aged 1860 years old with ASA grade II or I grade were selected for general anesthesia. The patients were induced after 10 minutes of calm in the room. Midazolam injection 0.05 mg / kg, propofol 1.5 mg / kg, when the patient lost consciousness, According to the dosage of fentanyl during anesthesia induction period, three groups were randomly divided into three groups, the dosage of fentanyl was 4ugr / kg / kg fentanyl and the dosage of fentanyl in group F6 was 5ugr / kg / kg / kg fentanyl, and the tracheal intubation was performed after complete muscle relaxation. Mechanical ventilation. Continuous monitoring and recording of heart rate, heart rate, heart rate, systolic blood pressure-SBP, diastolic blood pressure, diastolic blood pressure, heart rate, heart rate, heart rate, heart rate, systolic blood pressure, diastolic blood pressure, diastolic blood pressure, heart rate, heart rate and heart rate at 2 min after induction, immediately after tracheal intubation (tracheal insertion at 10 seconds, 1 min after intubation, 1 min after intubation) and 5 min after intubation (5 min after intubation), respectively, in order to monitor and record the heart rate of the patients at the time of entering the room, 2 min after induction, 2 min after induction, 2 min after induction, 2 min after induction, and 2 min after induction. And SPO _ 2, finger temperature, Perfusion index perfusion index (Pi) and fingertip photovolumic pulse wave were measured and parameters were measured: the amplitude of finger photovolumic pulse wave photoplethysmograph pulse wave amplitudea PPGAA, antegrade angle (偽 1C), posterior inclination angle (偽 2N, rise time t 1N, drop time t 2) and pulsating period pulse beat intervale PBII, and simultaneously pumping. The plasma concentrations of epinephrine (E) and norepinephrinene (NE) in plasma were measured. Results: compared with T1 and T2 and T5, PPGA and Pi were increased, E and NE were decreased, PPGA and Pi were decreased in F4 group and F5 group, and 偽 2 and NE were decreased in F4 group and F5 group. There was no significant change in E in P0.05 and F5 groups. PPGA and Pi increased at the time of T2T3, T4 and T5. Compared with T3, PPGA and Pi of F4 and F5 were increased, and all indexes of 偽 2E and NE decreased in P0.05F6 and 偽 2E, NE were decreased in F4 and F5, but there was no obvious difference in each index between T4 and T5 and F5, and no significant difference was found in each index of 偽 2E and NE decrease in P0.05F6 group (P 0. 05P 0. 05 F6) compared with T 3, T 4 and T 5 were higher than that in T 4 and T 5. There was no significant difference between the indexes of each group at the time of P0.05T _ 1 and T _ 4. The levels of PPGA and Pi in the F6 group were significantly higher than those in the F4 group and the F5 group were significantly lower than those in the F4 group and the F5 group respectively. There was a positive correlation between P0.05, 偽 2 and DBPNE, respectively. There was a negative correlation between P0.05, P0.05, PBI and DBPnE, respectively. Conclusion: the parameters of optoelectronic volume pulse wave, PPGAP, Pi and 偽 2, are negative correlation P0.055.Conclusion: the parameters of optoelectronic volume pulse wave, PPGAP, Pi and 偽 2 can be noninvasive, and the correlation between P0. 05 and P0. 05 is negative correlation between P0. 05 and P0. 05. Conclusion: there is no significant difference between P0. 05 and P0. 05, P 0. 05. Monitoring the nociceptive stress response of patients with general anesthesia in real time and effectively has certain significance for guiding clinical anaesthesia.
【學位授予單位】：石河子大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R614

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本文編號：1562549