本文選題：右美托咪定　切入點：腹腔鏡子宮全切　出處：《山西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討右美托咪定靜脈持續(xù)輸注對行婦科腹腔鏡子宮全切手術(shù)患者血流動力學(xué)及應(yīng)激反應(yīng)的影響。 方法擇期行婦科腹腔鏡子宮全切手術(shù)患者60例,ASA Ⅰ～Ⅱ級,隨機分為兩組：D組(右美托咪定組)和P組(對照組)。D組入室后以將0.6μg/kg負(fù)荷劑量的右美托咪定靜脈泵注10min泵完,再以0.4μg/kg/h速度持續(xù)泵入右美至手術(shù)結(jié)束前30分鐘,P組不泵入右美托咪定。兩組患者麻醉誘導(dǎo)、維持均相同。其中麻醉維持丙泊酚按序貫法TCI血漿靶控輸注,調(diào)整丙泊酚用量使BIS維持在45-50,手術(shù)中調(diào)節(jié)瑞芬太尼的用量維持BP波動在基礎(chǔ)值20%范圍左右。分別記錄入室后5分鐘病人安靜時(T0)、插管后lmin(T1)、手術(shù)開始時(T2)、氣腹形成后10min(T3)、解除氣腹后5min(T4)、拔管后5min(T5)6個時間點的平均動脈壓(MAP)和心率(HR)；檢測T0、T1、T3、T4、T5五個時間點外周血皮質(zhì)醇(cor)、腎上腺素(E)及去甲腎上腺素(NE)的濃度。 結(jié)果1.兩組患者年齡、體重指數(shù)、手術(shù)時間等一般情況比較差異均無統(tǒng)計學(xué)意義(P0.05)。 2.兩組患者平均動脈壓和心率在T0時點比較無統(tǒng)計學(xué)意義(P0.05),T1～5時點P組MAP明顯升高,HR明顯增快(P0.05)；D組MAP、HR變化不明顯。兩組比較差異有統(tǒng)計學(xué)意義(P0.05)。 3.兩組患者外周血皮質(zhì)醇濃度P組Tl、T3、T4、T5時點均高于基礎(chǔ)值,D組在T3、T4、T5時點與T0相比明顯降低(p0.05),兩組比較差異有統(tǒng)計學(xué)意義(P0.05)。 4.兩組患者外周血去甲腎上腺素濃度P組T1、T3、T4、T5時點均高于基礎(chǔ)值,D組在T1、T3、T4、T5時點與T0點相比無明顯變化。兩組比較差異有統(tǒng)計學(xué)意義(P0.05)。 5.兩組患者外周血腎上腺素濃度P組T1、T3、T4、T5時點均高于基礎(chǔ)值,D組在T1、T3、T4、T5時點與T0點相比無明顯變化。兩組比較差異有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論1.靜脈泵注右美托咪定可使患者圍手術(shù)期血流動力學(xué)更加穩(wěn)定。 2.靜脈泵注右美托咪定能抑制腎上腺素、去甲腎上腺素、皮質(zhì)醇的釋放,減輕麻醉手術(shù)時患者的的應(yīng)激反應(yīng)。
[Abstract]:Objective to investigate the effect of continuous intravenous infusion of dexmetomidine on hemodynamics and stress response in patients undergoing gynecological laparoscopic hysterectomy. Methods A total of 60 patients undergoing elective laparoscopic hysterectomy were randomly divided into two groups: group D (group D) and group P (group P), who were injected with 0.6 渭 g / kg dexmetomidine intravenously for 10 minutes. At the speed of 0.4 渭 g / kg / h, the right metopropofol was continuously pumped into the right side until 30 minutes before the end of the operation. The anesthesia induction in both groups was the same as that in the control group, in which propofol was administered by sequential TCI plasma target control infusion. Adjusting the dosage of propofol to maintain BIS at 45-50 and adjusting the dosage of remifentanil to keep BP fluctuating in the range of 20% or so during operation. The patients were recorded at 5 minutes after entering the room during quiet time of T0, after intubation, after intubation, at the beginning of operation, T2 and pneumoperitoneum were formed. The mean arterial pressure (MAPP) and heart rate (HRT) were measured at 5 min after pneumoperitoneum, 5 min after extubation and 5 min after extubation, and the concentrations of cortisone, epinephrine (E) and norepinephrine (NE) in peripheral blood were detected at 5 time points. Results 1. There was no significant difference in age, body mass index and operation time between the two groups (P 0.05). 2. There was no significant difference in mean arterial pressure and heart rate between the two groups at T0. There was no significant difference in MAP and HR between the two groups at the time of T0. The difference between the two groups was statistically significant (P 0.05). 3. The concentration of cortisol in the peripheral blood of group P was significantly lower than that of group D at the time of T _ 3 T _ 4 T _ 5 and T _ 0, and there was a significant difference between the two groups (P 0.05), which was significantly higher than that in group D (P < 0.05), and the concentration of cortisol in group P was significantly lower than that in group D at T _ 3 / T _ (4) T _ (5) compared with T _ (0). 4. The concentration of norepinephrine in peripheral blood of group P was significantly higher than that of group D at T _ (1) T _ (3) T _ (3) T _ (4) T _ (5) and T _ (0). The difference between the two groups was statistically significant (P < 0.05), and there was no significant difference between the two groups at T _ (1) T _ (3) T _ (4) T _ (5) and T _ (0). 5. The concentration of epinephrine in the peripheral blood of group P was significantly higher than that of group D at T _ (1) T _ (3) T _ (3) T _ (4) T _ (5) and T _ (0). The difference between the two groups was statistically significant (P < 0.05), and there was no significant difference between the two groups at T _ (1) T _ (3) and T _ (4) T _ (5). Intravenous injection of dexmetidine can make hemodynamics more stable in perioperative period. 2. 2. Intravenous injection of dexmetidine inhibited the release of epinephrine, norepinephrine and cortisol, and alleviated the stress response of patients undergoing anesthesia.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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