本文選題：婦科腹腔鏡手術(shù)　切入點：腦氧飽和度　出處：《皖南醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察圍術(shù)期大腦血氧飽和度(Cerebral oxygen saturation,SCTO2)變化對女性腔鏡手術(shù)術(shù)后惡心嘔吐(Postoperative nausea and vomiting,PONV)的影響,并探討女性腔鏡手術(shù)術(shù)后發(fā)生惡心嘔吐的機制。方法:選取擇期全身麻醉方式患者120例:婦科腔鏡手術(shù)60例、婦科開腹手術(shù)30例和女性腔鏡膽囊手術(shù)30例,分為A、B、C、D四組,A組:婦科腔鏡手術(shù)30例;B組:婦科開腹手術(shù)30例;C組:婦科腔鏡手術(shù)30例,手術(shù)開始前以0.5g/kg劑量快速靜脈滴注20%甘露醇;D組:女性腔鏡膽囊手術(shù)30例。分別在T1:入室5min、T2:插喉罩后5min、T3:建立氣腹、體位變化即刻、T4:建立氣腹后15min、T5:排氣體位變化即刻、T6:排氣后10min這六個時間點觀測四組患者圍術(shù)期SCTO2、平均椎動脈血流速度(Vertebral artery average blood flow velocity,VM)和椎動脈血管阻力(vertebral artery vascular resistance,RI)變化以及術(shù)后48h內(nèi)患者PONV的發(fā)生率。結(jié)果:在圍術(shù)期,所有患者腦氧飽和度都緩慢上升,在T4、T5兩個時間點,B、C、D三組術(shù)中SCTO2低于A組,有統(tǒng)計學(xué)意義(P0.05);C組術(shù)中VM高于A組,有統(tǒng)計學(xué)意義(P0.05)。T5時間點,D組術(shù)中VM顯著高于于A組,有統(tǒng)計學(xué)意義(P0.05)。T4時間點,D組RI低于其余三組,有統(tǒng)計學(xué)意義(P0.05)。術(shù)后24h內(nèi),B、C、D三組發(fā)生惡心嘔吐例數(shù)均小于A組,有統(tǒng)計學(xué)意義(P0.05);且C組發(fā)生惡心嘔吐例數(shù)明顯低于B、D兩組,有統(tǒng)計學(xué)差異(P0.05)。術(shù)后48h內(nèi),B、C、D三組惡心嘔吐發(fā)生率明顯低于A組,有統(tǒng)計學(xué)意義(P0.05);B、C、D三組間無明顯統(tǒng)計學(xué)差異(P0.05)。結(jié)論:女性腔鏡手術(shù)術(shù)中患者顱內(nèi)壓升高使大腦氧耗減少,可導(dǎo)致SCTO2升高。圍術(shù)期,腦氧飽和度升高和頸椎動脈平均血流速度減少,都可以增加女性腔鏡手術(shù)PONV的發(fā)生率。
[Abstract]:Objective: to observe the effect of changes of cerebral oxygen saturation during perioperative period on postoperative nausea and vomiting PONV2 in female patients undergoing endoscopic surgery. Methods: 120 patients with elective general anesthesia were selected, including 60 gynecological endoscopic surgery, 30 gynecologic laparotomy and 30 female endoscopic cholecystectomy. The patients were divided into four groups: group A: gynecological endoscopic surgery (group B): gynecologic laparotomy group (group C): gynecological endoscopic surgery (group C), gynecological endoscopic surgery (group A, n = 30). Before operation, 20% mannitol intravenously injected with 0.5 g / kg was given to 20% mannitol group D: 30 cases of female cholecystectomy were performed by endoscopic cholecystectomy, respectively at T1: 5 min after laryngeal mask insertion, 5 min after larynx mask, and 5 min after insertion of larynx mask: to establish pneumoperitoneum, and to establish pneumoperitoneum. Immediate postural change: 15 min after establishment of pneumoperitoneum, T5: change of ventral position: change of ventral position immediately and T6: observation of perioperative SCTO2, mean vertebral artery artery average blood flow velocityVMs and vertebral artery vascular resistance (vertebral artery vascular resistance RI) in four groups of patients during perioperative period (SCTO2, mean vertebral artery flow velocity (VMV)) and vertebral artery resistance (vertebral artery vascular resistance) (RI) were observed at six time points after pneumoperitoneum (Pneumoperitoneum pneumoperitoneum). Results: during the perioperative period, the incidence of PONV was observed within 48 hours after operation. The cerebral oxygen saturation increased slowly in all the patients. The SCTO2 in group D was lower than that in group A at two time points of T4 and T5, and the intraoperative VM in group C was significantly higher than that in group A, and the VM in group D was significantly higher than that in group A. The RI of group D was significantly lower than that of the other three groups, and the number of nausea and vomiting in group D was lower than that in group A within 24 hours after operation, and the number of cases of nausea and vomiting in group C was significantly lower than that in group BD, and the incidence of nausea and vomiting in group C was significantly lower than that in group B (P < 0.05), and the incidence of nausea and vomiting in group C was significantly lower than that in group B (P < 0.05). The incidence of nausea and vomiting in group D was significantly lower than that in group A within 48 hours after operation, and there was no significant difference among the three groups. Conclusion: the increase of intracranial pressure in female patients during endoscopic surgery reduces cerebral oxygen consumption. During perioperative period, increased cerebral oxygen saturation and decreased mean blood flow velocity of cervical artery increased the incidence of PONV in female endoscopic surgery.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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本文編號：1631469