本文選題：地佐辛　切入點(diǎn)：布托啡諾　出處：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：近年來(lái),隨著麻醉學(xué)的發(fā)展,特別是新的阿片類鎮(zhèn)痛藥物的不斷出現(xiàn),帶來(lái)了麻醉管理的新問題,其中麻醉深度的定義及監(jiān)測(cè)為這些問題的關(guān)鍵,這對(duì)提高麻醉管理水平,改善麻醉質(zhì)量具有重要影響。目前已知,阿片類藥物對(duì)麻醉深度的影響,國(guó)內(nèi)外報(bào)道很多,取得了一定進(jìn)展,獲得了一定經(jīng)驗(yàn),但是主要集中在吸入麻醉下(如七氟醚吸入),研究其在靜脈麻醉下影響,報(bào)到較少。在此前提下,本研究通過(guò)選擇阿片受體激動(dòng)-拮抗劑地佐辛、布托啡諾與目前臨床常用的阿片受體激動(dòng)劑芬太尼、舒芬太尼分別應(yīng)用于丙泊酚靶控輸注(targetcontrolled infusion TCI)全麻過(guò)程中,來(lái)探討常見阿片類鎮(zhèn)痛藥物對(duì)腦電雙頻譜指數(shù)(bispectral index,BIS)和聽覺誘發(fā)電位指數(shù)(auditory evoked potential index,AEPI)的影響,從而為臨床麻醉中合理使用阿片類藥物提供參考。 第一部分：等效鎮(zhèn)痛劑量的不同阿片類藥物對(duì)丙泊酚TCI全身麻醉下BIS和AEPI的影響 目的：研究等效鎮(zhèn)痛劑量的不同阿片類藥物對(duì)丙泊酚TCI全麻下患者血流動(dòng)力學(xué)及BIS、AEPI的影響。 方法：擇期全麻手術(shù)患者100例,隨機(jī)均分為5組,每組20例,2%利多卡因經(jīng)喉噴充分表面麻醉,5組均采用靶控輸注丙泊酚起始血漿靶濃度為1.0μg/ml,以0.5μg/ml濃度梯度增加直至BIS≤60且AAI≤40時(shí),靜脈注射羅庫(kù)溴銨0.6mg/kg,進(jìn)行麻醉誘導(dǎo),氣管插管,機(jī)械通氣,同時(shí)以丙泊酚血漿靶控(TCI)3-4μg/ml維持麻醉狀態(tài),待血流動(dòng)力學(xué)穩(wěn)定且BIS60,AAI40,分別靜脈注射地佐辛0.1mg/kg(D組),布托啡諾0.02mg/kg(B組),芬太尼1μg/kg(F組),舒芬太尼0.1μg/kg(S組),生理鹽水5ml(N組),觀察并記錄全麻誘導(dǎo)前(T)、給藥前(基礎(chǔ)值)(To)、給藥后3min(T1)、6min(T2)、9min(T3)、12min(T4).15min(T5)各時(shí)點(diǎn)的BIS、AAI、MAP、HR。 結(jié)果：5組HR和MAP的變化無(wú)差異；5組間相比,F組、S組與N組之間BIS、AAI無(wú)差異,在T2-T5時(shí)點(diǎn)D組與B組的BIS、AAI與N組、F組、S組相比差異有統(tǒng)計(jì)學(xué)意義(P0.05),D組與B組各時(shí)點(diǎn)BIS、AAI變化無(wú)差異；與To比較,D組、B組BIS值和AAI值T2-T5明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),F組、S組和N組BIS、AAI變化無(wú)差異。 結(jié)論：在丙泊酚TCI全身麻醉下,等效鎮(zhèn)痛劑量的芬太尼和舒芬太尼在穩(wěn)定血流動(dòng)力學(xué)同時(shí)對(duì)BIS值、AAI值影響較小,不影響麻醉深度的判斷；而等效鎮(zhèn)痛劑量的地佐辛和布托啡諾具有穩(wěn)定血流動(dòng)力學(xué)的作用,但會(huì)升高丙泊酚麻醉下的BIS值、AAI值,進(jìn)而影響對(duì)麻醉深度的判斷。 第二部分：不同劑量的地佐辛對(duì)丙泊酚TCI全麻下BIS和AEPI的影響 目的：研究不同劑量的地佐辛對(duì)丙泊酚TCI全麻下對(duì)患者血流動(dòng)力學(xué)及BIS、AEPI的影響。 方法：擇期全麻手術(shù)患者80例,將患者隨機(jī)分為4組(n=20)：2%利多卡因經(jīng)喉噴充分表面麻醉,4組患者靶控輸注丙泊酚,起始血漿靶濃度為1.0μg/ml,以0.5μg/ml濃度梯度增加直至BIS≤60且AAI≤40時(shí),靜脈注射羅庫(kù)溴銨0.6mg/kg,氣管插管,機(jī)械通氣,同時(shí)以丙泊酚血漿靶濃度3-4μg/ml維持麻醉,待血流動(dòng)力學(xué)穩(wěn)定且BIS60,AAI40,分別靜脈注射地佐辛0.05mg/kg(D1組)、0.1mg/kg(D2組)、015mg/kg(D3組),芬太尼1μg/kg(F組)。記錄全麻誘導(dǎo)前(T)、給藥前即刻(基礎(chǔ)值)(T0)、給藥后3min(T1)、6min(T2)、9min(T3)、12min(T4)、15min(T5)各時(shí)點(diǎn)的BIS、AAI、MAP、HR。結(jié)果：與F組比較,D1組在給藥后MAP、HR、BIS和AAI升高,(P0.05),而D3組給藥后MAP、BIS、AAI相對(duì)F組各時(shí)點(diǎn)比較無(wú)明顯差異(P0.05),D2組給藥后與D1組對(duì)應(yīng)各時(shí)點(diǎn)變化無(wú)差異；與To比較,D1組各時(shí)點(diǎn)HR、MAP、BIS和AAI明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),D2組相對(duì)基礎(chǔ)值HR、BIS值和AAI值明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),D3組在T2-T5時(shí)點(diǎn)MAP、BIS、AAI相對(duì)基礎(chǔ)值T0變化無(wú)差異(P0.05)。結(jié)論：不同劑量地佐辛與丙泊酚靜脈全身麻醉患者麻醉深度存在相關(guān)性,其在穩(wěn)定血流動(dòng)力學(xué)的同時(shí)增加丙泊酚靜脈麻醉期間的BIS和AAI,從而影響對(duì)麻醉深度的判斷。
[Abstract]:In recent years, with the development of Anesthesiology, especially new opioid analgesic drugs appear constantly, brought new problems of anesthetic management, including the definition and monitoring of anesthesia depth is the key to these problems, to improve the management level of anesthesia, improve the quality of anesthesia has important influence. It is now known that opioids for influence of anesthesia depth, there are many reports, has made some progress, gained some experience, but mainly concentrated in the inhaled anesthesia (such as sevoflurane), the study reported less effect under intravenous anesthesia. Under this premise, this study through the selection of opioid agonist antagonist dezocine, Bhutto Brown Nobel and commonly used opioid receptor agonist clinical fentanyl, sufentanil infusion were used in control of propofol (targetcontrolled infusion TCI) during general anesthesia to discuss common opioid analgesic drugs on The effects of bispectral index (BIS) and auditory evoked potential index (auditory evoked potential index, AEPI) are discussed, so as to provide references for rational opioid use in clinical anesthesia.
The first part: the effect of different opioids on the equivalent analgesic dose on BIS and AEPI under propofol TCI general anesthesia
Objective: To study the effect of different opioids on the hemodynamics, BIS and AEPI in patients with propofol TCI general anesthesia.
鏂規(guī)硶錛氭嫨鏈熷叏楹繪墜鏈?zhèn)ｈ�，

本文編號(hào)：1716778