本文選題：0.5%羅哌卡因　切入點(diǎn)：切口浸潤(rùn)　出處：《中南大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：開(kāi)顱手術(shù)切皮前應(yīng)用局麻藥物切口浸潤(rùn)可通過(guò)阻斷外周疼痛傳導(dǎo)的途徑減少麻醉用藥的用量,減輕術(shù)中患者血流動(dòng)力學(xué)波動(dòng)及抑制手術(shù)中應(yīng)激反應(yīng)的強(qiáng)度。本研究通過(guò)觀察在術(shù)中使用羅哌卡因切口浸潤(rùn)麻醉后,對(duì)高選擇性癲癇病灶切除術(shù)的患者術(shù)后早期認(rèn)知功能的影響,了解其臨床應(yīng)用的價(jià)值。 方法：經(jīng)湖南省腦科醫(yī)院倫理委員會(huì)批準(zhǔn),選取本院2013年10月-2014年4月行癲癇病灶切除術(shù)患者共40例,病灶部位均為右側(cè)顳葉,手術(shù)方式為高選擇性癲癇病灶切除術(shù),ASA Ⅰ-Ⅱ級(jí),年齡18-45歲。將患者隨機(jī)分成兩組每組各20例,即羅哌卡因?qū)嶒?yàn)組(R組)與生理鹽水對(duì)照組(C組)。手術(shù)切皮前實(shí)驗(yàn)組給予0.5%羅哌卡因200mg(40m1)切口周?chē)䴘?rùn)阻滯,對(duì)照組于切皮前給予等容的生理鹽水亦行切口浸潤(rùn)。兩組患者選擇的麻醉方式均為全麻氣管內(nèi)插管機(jī)械控制呼吸。誘導(dǎo)麻醉用藥具體為：咪達(dá)唑侖(0.05mg/kg),丙泊酚(1mg/kg),芬太尼(3ug/kg),阿曲庫(kù)胺(0.6mg/kg).術(shù)中根據(jù)需要調(diào)整丙泊酚注射液泵注速度；以及間斷追加芬太尼注射液維持患者鎮(zhèn)靜鎮(zhèn)痛；另予以阿曲庫(kù)胺注射維持手術(shù)必要的肌松。術(shù)中持續(xù)正壓控制呼吸,根據(jù)個(gè)體情況調(diào)整呼吸參數(shù)。并且術(shù)中通過(guò)BIS值監(jiān)測(cè)維持手術(shù)麻醉深度(BIS值控制在40-55)。密切監(jiān)測(cè)患者術(shù)中生命體征情況,維持血壓波動(dòng)范圍在術(shù)前血壓±20%,如果術(shù)中血壓低至基礎(chǔ)血壓的20%以下,則根據(jù)病因進(jìn)行處理。術(shù)中選取特定的時(shí)間點(diǎn)分別記錄下兩組患者M(jìn)AP、心率,另在T1(麻醉誘導(dǎo)前10min)、T2(手術(shù)切皮后10min)、T3(入術(shù)后復(fù)蘇室后10min)抽血查患者血糖和血清皮質(zhì)醇值。分別記錄兩組患者術(shù)中輸液量、尿量、失血量、及手術(shù)耗時(shí)時(shí)間,統(tǒng)計(jì)術(shù)中麻醉藥用量。術(shù)畢蘇醒后出術(shù)后復(fù)蘇室后均使用術(shù)后鎮(zhèn)痛泵鎮(zhèn)痛。鎮(zhèn)痛用藥均為：舒芬太尼2μ g／kg+托烷司瓊5mg,以生理鹽水稀釋至80ml。本研究對(duì)所有患者術(shù)前及術(shù)后進(jìn)行兩次神經(jīng)精神功能測(cè)試。內(nèi)容為選擇韋氏成人智力量表及記憶量表里的7項(xiàng)敏感項(xiàng)目,兩次測(cè)試時(shí)間分別在術(shù)前1天和術(shù)后7天。判定術(shù)后認(rèn)知功能障礙的標(biāo)準(zhǔn)為國(guó)際術(shù)后認(rèn)知功能障礙研究組推薦的復(fù)合Z分法——即復(fù)合Z分大于1.96亦可是超過(guò)兩項(xiàng)測(cè)驗(yàn)中出現(xiàn)的單次Z分大于1.96可診斷術(shù)后認(rèn)知功能障礙。 結(jié)果：1.兩組患者對(duì)比一般情況如性別比例、年齡、身高體重、ASA分級(jí)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；兩組患者術(shù)中情況如手術(shù)時(shí)間、出血量、尿量、輸液用量、及術(shù)中咪達(dá)唑侖和阿曲庫(kù)胺藥物用量無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；2.兩組患者在術(shù)中T2時(shí)的血清皮質(zhì)醇值比較,R組較C組比數(shù)值降低顯著,有統(tǒng)計(jì)學(xué)差異(P0.05),而兩組患者各時(shí)間點(diǎn)的血糖值比較無(wú)統(tǒng)計(jì)學(xué)差異；3.兩組患者術(shù)中芬太尼及丙泊酚用量對(duì)比：C組芬太尼的總量為1.02±0.18mg，R組芬太尼總量為0.74±0.13mg。R組芬太尼總量較對(duì)照組減少,有統(tǒng)計(jì)學(xué)差異(P0.05)；C組丙泊酚用量為883.31±212.43mg,R組丙泊酚用量為543.28±176.53mg,R組與C組對(duì)比有統(tǒng)計(jì)學(xué)差異(P0.05)；4.兩組患者術(shù)后認(rèn)知功能情況比較：R組患者(0.5%羅哌卡因組)有2例病人出現(xiàn)了早期術(shù)后認(rèn)知功能改變,發(fā)生率為10%；C組(生理鹽水組)有6例病人出現(xiàn)了早期術(shù)后認(rèn)知功能改變,發(fā)生率為30%。R組較C組比較其差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論：1.癲癇患者行高選擇性癲癇病灶切除術(shù)中應(yīng)用0.5%羅哌卡因切口浸潤(rùn)可以減少術(shù)中芬太尼和丙泊酚的用量。2.癲癇患者行高選擇性癲癇病灶切除術(shù)中應(yīng)用0.5%羅哌卡因切口浸潤(rùn)可以降低術(shù)后早期認(rèn)知功能障礙的發(fā)生率。圖4幅,表10個(gè),參考文獻(xiàn)34篇。
[Abstract]:Objective: local anesthetic infiltration can be incision by blocking the way of peripheral pain reduction of anesthetic drug dosage before skin incision craniotomy, lessen the intensity of hemodynamic fluctuations and inhibition of the stress response during surgery during the operation. The aim of this study was to use ropivacaine incision during operation after infiltration anesthesia effect on early cognitive function high selective resection of epileptic patients, understand the value of its clinical application.
Methods: with the approval of the Hunan provincial Brain Hospital Ethics Committee of the hospital in October 2013 April -2014 for epileptic foci resection were 40 cases, the lesion was the right temporal lobe, the operation mode for the high selectivity of epileptic foci resection, ASA I-II, age 18-45 years old. The patients were divided into two groups of the 20 cases, namely the ropivacaine group (group R) and saline control group (C group). The surgical incision in the experimental group were given 0.5% ropivacaine 200mg (40m1) incision infiltration around the block, in the control group before skin incision with saline tolerance also incision infiltration. Two groups of patients with choice of anesthesia for general anesthesia endotracheal intubation mechanical ventilation induced anesthesia. Specifically: midazolam (0.05mg/kg), propofol (1mg/kg), fentanyl (3ug/kg), atracurium (0.6mg/kg) during the operation. According to the need to adjust the infusion speed and Propofol Injection; Intermittent fentanyl injection to maintain sedation analgesia; the other to atracurium injection to maintain the necessary surgical muscle relaxant. Intraoperative continuous positive pressure breathing control, according to the individual situation. And adjust respiratory parameters by intraoperative BIS monitoring to maintain the depth of anesthesia (BIS value is 40-55). Close monitoring of vital signs during surgery the situation, to maintain blood pressure fluctuation in preoperative blood pressure + 20%, if intraoperative low blood pressure to basal blood pressure below 20%, according to the etiology. Select the specific time points were recorded in two groups of patients with MAP, the heart rate in the operation, the other in the T1 (10min before induction of anesthesia (T2), after surgical incision 10min (T3), into the recovery room after surgery and 10min) to check blood glucose and serum cortisol values were recorded. The patients in the two groups of patients with transfusion volume, urine volume, blood loss, and the operation time, amount of intraoperative anesthetic surgery recovery after surgery. After the recovery room after the use of postoperative analgesia pump. Analgesia were: sufentanil 2 g / kg+ 5mg tropisetron, two neuropsychological tests for all patients before and after diluted with saline to 80ml.. The research content for the selection of 7 sensitive items Wechsler Adult Intelligence amount table and memory scale, two test time respectively before 1 days and 7 days after operation. Determine the postoperative cognitive dysfunction criteria for postoperative cognitive dysfunction in the international research group recommended that Z composite method of Z composite is greater than 1.96 but also more than a single Z is greater than 1.96 can be divided into diagnosis postoperative cognitive dysfunction in two test.
Results: 1. patients in the two groups were compared with the general situation of sex ratio, age, height and weight, there was no significant difference in ASA grade (P0.05); the two groups of patients in the operation time, bleeding volume, urine volume, transfusion amount, and intraoperative midazolam and atracurium dosage had no statistical difference (P0.05; 2.) serum cortisol in two groups of patients with intraoperative T2 value when compared to the R group than in C group was significantly lower than the values, there were significant differences (P0.05), and the two groups of patients with blood glucose values showed no significant difference; 3. patients in the two groups of fentanyl and propofol dosage were compared: the total amount of fentanyl group C was 1.02 + 0.18mg, R + 0.13mg.R group fentanyl total 0.74 total fentanyl group compared with the control group decreased, there was significant difference (P0.05); the dosage of propofol in group C was 883.31 + 212.43mg, the dosage of propofol in group R was 543.28 + 176.53mg, R group and C group compared with significant difference (P0.05); compare the cognitive function of the patients of 4. groups: two patients in group R (0.5% ropivacaine group) in 2 cases of early postoperative cognitive function change, the incidence rate was 10%; C group (saline group) in 6 cases of early postoperative cognitive function change, incidence rate there was statistical significance in 30%.R group than in C group compared the difference (P0.05).
Conclusion: 1. epilepsy patients underwent high selective resection of epileptic foci infiltration may infiltrate can reduce postoperative cognitive dysfunction in early stage of the occurrence rate of application of 0.5% ropivacaine fentanyl and propofol in the operation incision to reduce the dosage of.2. in patients with epilepsy in highly selective epileptic focus resection in the application of 0.5% ropivacaine incision. 4 charts, 10 tables and reference 34 articles.

【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R614

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