本文選題：芬太尼　切入點(diǎn)：肺癌　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：觀察肺癌患者行開胸手術(shù)時(shí)同等劑量芬太尼的兩種給藥方案對(duì)患者術(shù)中血流動(dòng)力學(xué)及其全麻蘇醒期躁動(dòng)的影響。 方法：選擇自2012年8月至2013年12月在我院行肺癌手術(shù)的ASA II-III級(jí)、年齡50-70歲、體重60-80kg的患者68例,隨機(jī)分為A組(超前陣痛組)和B組（術(shù)中追加組）,每組34例，兩組在性別、年齡、體重、ASA分級(jí)等方面無顯著統(tǒng)計(jì)學(xué)差異，資料具有可比性。 患者入室后常規(guī)監(jiān)測(cè)血壓（BP）、心電圖（ECG）、心率（HR）、血氧飽和度（SpO2）、中心靜脈壓（CVP）、腦電雙頻指數(shù)（BIS）等。兩組均靜脈注射咪達(dá)唑侖0.08mg/kg、順苯磺酸阿曲庫(kù)銨0.15mg/kg、依托咪酯脂肪乳0.3mg/kg、枸櫞酸芬太尼進(jìn)行全麻誘導(dǎo)，誘導(dǎo)時(shí)除芬太尼其余藥物劑量相同。輸注順苯磺酸阿曲庫(kù)銨3-5min后插入氣管導(dǎo)管,接呼吸機(jī)行機(jī)械通氣，術(shù)中以順式阿曲庫(kù)銨0.04-0.08mg/kg間斷靜脈推注，根據(jù)生命體征以丙泊酚4-12mg/(kg.h)、瑞芬太尼0.25μg/(kg.min)泵注維持麻醉。A組誘導(dǎo)時(shí)給予芬太尼4μg/kg，手術(shù)開始前5min給予芬太尼3μg/kg。而B組誘導(dǎo)時(shí)給予芬太尼3μg/kg，手術(shù)開始前5min給予芬太尼2μg/kg，隨后每隔一小時(shí)給予1μg/kg。最終兩組患者給予的芬太尼總量均為7μg/kg。監(jiān)測(cè)并記錄兩組患者分別在誘導(dǎo)前(T0)、誘導(dǎo)后(T1)、插管后(T2)、手術(shù)開始后(T3)、手術(shù)開始后1小時(shí)(T4)、手術(shù)結(jié)束時(shí)(T5)、拔管時(shí)(T6)、拔管后15分鐘時(shí)(T7)測(cè)得的收縮壓(SBP)、平均動(dòng)脈壓(MAP)、脈搏(HR)。監(jiān)測(cè)蘇醒指標(biāo)、觀察拔管后副反應(yīng)、進(jìn)行拔管后VAS疼痛評(píng)分及Riker躁動(dòng)-鎮(zhèn)靜評(píng)分。 結(jié)果：（1）兩組病人的一般情況，誘導(dǎo)前(T0)收縮壓、平均動(dòng)脈壓、脈搏、腦電雙頻指數(shù)均無顯著性差異（P0.05)。（2）術(shù)中追加組在T2、T3兩時(shí)間點(diǎn)血流動(dòng)力學(xué)變化較超前鎮(zhèn)痛組明顯，有顯著性差異（P0.05）。（3）兩組患者呼吸恢復(fù)時(shí)間、睜眼時(shí)間、準(zhǔn)確完成指令時(shí)間和拔管時(shí)間等蘇醒指標(biāo)間有顯著性差異（P0.05）。(4)兩組拔管后躁動(dòng)和嗜睡患者間有顯著性差異（P0.05）。（5）兩組患者相比較，拔管后5min、10min、15min時(shí)無疼痛的患者間比較有顯著性差異（P0.05）。拔管后5min、10min時(shí)自述有能忍受的輕微疼痛的患者間比較有顯著性差異（P0.05）。拔管后15min時(shí)自述疼痛影響睡眠的患者間比較有顯著性差異（P0.05）。（6）拔管后，兩組平靜合作和非常躁動(dòng)的患者間比較有顯著性差異（P0.05）。 結(jié)論：超前鎮(zhèn)痛組患者較術(shù)中追加組患者血流動(dòng)力學(xué)更加穩(wěn)定，鎮(zhèn)痛效果佳，，且蘇醒期躁動(dòng)樣本數(shù)少，蘇醒迅速平穩(wěn)，麻醉并發(fā)癥少，可以作為肺癌開胸手術(shù)全身麻醉的一種有價(jià)值的方法。
[Abstract]:Aim: to observe the effect of two same dosage of fentanyl on hemodynamics and restlessness during general anesthesia in patients with lung cancer. Methods: from August 2012 to December 2013, 68 patients with ASA II-III, aged 50-70 years old and weighing 60-80kg, who underwent lung cancer surgery in our hospital from August 2012 to December 2013 were randomly divided into two groups: group A (preemptive labor pain group) and group B (intraoperative supplementation group, 34 cases in each group). There was no significant difference in age, weight and ASA grading, and the data were comparable. After entering the room, the patients were routinely monitored for blood pressure BPU, electrocardiogram (ECG), ECGG, HRT, SPO _ 2, CVP, BIS.Meidazolam 0.08 mg / kg, atracurium cis-benzenesulfonate 0.15 mg / kg, mididazolam 0.3mg / kg, probiotic fat milk 0.3 mg / kg, respectively. Fentanyl citrate was induced by general anesthesia. After 3-5 minutes of infusion of atracurium sulfonic acid, the trachea catheter was inserted into the trachea, and mechanical ventilation was performed by ventilator. The intravenous injection of cis-atracurium 0.04-0.08 mg / kg was performed during induction. According to vital signs, propofol 4-12 mg / kg 路kg 路h 路h, remifentanil 0.25 渭 g / kg 路min) was administered to group A with 4 渭 g / kg fentanyl during induction and 3 渭 g / kg 路kg ~ (-1) of fentanyl 5 minutes before operation. In group B, fentanyl 3 渭 g / kg was given 5 minutes before operation, and 2 渭 g / kg of fentanyl was given 5 minutes before operation. The total amount of fentanyl given to each group was 7 渭 g / kg. after induction, T0, T1, T2, T3, T4 and T4 were monitored and recorded before induction, after induction, after intubation, and 1 hour after operation, respectively. Systolic blood pressure (SBP), mean arterial pressure (MAPP), pulse time (HRP) and recovery index were monitored. Side effects after extubation were observed, VAS pain score and Riker restlessness-sedation score after extubation were performed. Results there was no significant difference in systolic blood pressure, mean arterial pressure, pulse and bispectral index of EEG between the two groups (P < 0.01). The hemodynamic changes in the supplementary group at T _ 2 / T _ 3 were significantly higher than those in the preemptive analgesia group. There was significant difference in recovery time of respiration, time of eye opening, time of accurate completion of instruction and time of extubation between the two groups (P 0.05. 05. 4) there was significant difference between the two groups after extubation in restlessness and sleepiness (P 0. 05. 05. 5) the difference between the two groups was significant (P < 0. 05. 5), and there was no significant difference between the two groups (P < 0. 05. 5) after extubation, there was a significant difference between the two groups of patients with restlessness and somnolence after extubation. There was significant difference between the patients who had no pain at 5 min or 10 min after extubation (P 0.05). There was a significant difference between the patients who reported that they could endure mild pain at 5 min or 10 min after extubation. There was a significant difference between the patients who reported that the pain affected sleep 15 min after extubation. There was a significant difference between the patients who reported that the pain affected their sleep 15 minutes after extubation. There were significant differences between the patients who reported that the pain affected their sleep 15 minutes after the extubation of the tube. There was significant difference after extubation. There was a significant difference between the two groups in calm cooperation and very restless patients (P 0.05). Conclusion: the patients in the preemptive analgesia group are more stable in hemodynamics than those in the supplementary group during the operation. The analgesic effect is better than that in the preemptive analgesia group. It can be used as a valuable method of general anesthesia for lung cancer open chest surgery.
【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)】：R734.2

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