本文選題：右美托咪定 + 全身麻醉　； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：目的：觀察在全身麻醉時持續(xù)輸注右美托咪定對進(jìn)行骨科手術(shù)的老年患者的機(jī)體應(yīng)激反應(yīng)和術(shù)后恢復(fù)質(zhì)量的影響。方法：選擇ASAI-Ⅱ級擇期在全身麻醉下進(jìn)行胸、腰椎手術(shù)或全髖關(guān)節(jié)置換術(shù)的老年患者(65-85歲)22例參加這項(xiàng)前瞻性、隨機(jī)化、單盲及安慰劑對照的研究。所有患者被隨機(jī)分為右美托咪定組(D組,n=11)和對照組(C組n=11),兩組患者均進(jìn)行標(biāo)準(zhǔn)化的麻醉誘導(dǎo)。D組患者在誘導(dǎo)后開始注射右美托咪定0.4μg/kg/hr,直至手術(shù)結(jié)束前3Omin停止；C組患者以0.9%氯化鈉溶液代替右美托咪定,用法、用量與D組相同。觀察記錄患者在術(shù)前(T0)、劃皮前(T1)、劃皮后(T2)、氣管拔管前(T3)和氣管拔管后(T4)的平均動脈壓(MAP)和心率(HR)。記錄患者在進(jìn)入和離開麻醉后監(jiān)測治療室(PACU)時的鎮(zhèn)靜程度(Ramsay評分)。記錄患者在進(jìn)入和離開PACU及術(shù)后第一天、術(shù)后第三天時的疼痛強(qiáng)度(VAS評分),并在術(shù)后第三天時完成評價術(shù)后恢復(fù)質(zhì)量的QoR-40量表。檢測患者術(shù)前、手術(shù)開始后1hr、進(jìn)入PACU及術(shù)后第一天時的血糖、乳酸、胰島素、皮質(zhì)醇、游離脂肪酸濃度,檢測術(shù)前和術(shù)后第一天時的血清腎上腺素和去甲腎上腺素濃度。結(jié)果：兩組患者在一般資料和手術(shù)時間、麻醉時間、術(shù)中使用阿片類藥物總量上沒有統(tǒng)計(jì)學(xué)差異。右美托咪定組在T1、T2、T3時的MAP顯著低于T0(P0.05),但兩組間沒有明顯差異。拔管前后,右美托咪定組的MAP、HR無明顯改變,而對照組中MAP(P0.05)和HR(P0.05)均顯著上升。進(jìn)入PACU時,右美托咪定組的Ramsay評分顯著高于對照組(P0.05),到離開PACU時,兩組之間Ramsay評分和VAS評分均沒有差異。術(shù)后第一天時,右美托咪定組乳酸濃度(P0.05)和腎上腺素濃度(P0.01)低于術(shù)前并顯著低于對照組,對照組乳酸濃度和去甲腎上腺素濃度顯著高于術(shù)前(P0.05),兩組患者在術(shù)后第三天時的QoR-40量表評分沒有統(tǒng)計(jì)學(xué)差異。結(jié)論：老年患者進(jìn)行全身麻醉下的骨科手術(shù)時,術(shù)中持續(xù)注射0.4μg/kg/hr右美托咪定可抑制拔管期間的血流動力學(xué)波動,對術(shù)后第一天時的應(yīng)激反應(yīng)有一定抑制作用,對于術(shù)后恢復(fù)質(zhì)量沒有顯著改善。
[Abstract]:Aim: to observe the effect of continuous infusion of dexmetomidine during general anesthesia on stress response and postoperative recovery quality in elderly patients undergoing orthopaedic surgery.Methods: a prospective, randomized, single-blind and placebo-controlled study was conducted in 22 elderly patients aged 65 to 85 who underwent thoracic, lumbar or total hip replacement under general anesthesia.All patients were randomly divided into dexmetomidine group (D group) and control group (group C). Both groups were given standardized anesthesia induction. Group D began to inject dexmetomidine 0.4 渭 g / kg / kg 路h / h after induction, until the end of the operation, 3Omin stopped the treatment of group C.Patients were treated with 0.9% sodium chloride solution instead of dexmetomidine,The usage and dosage were the same as those in group D.The mean arterial pressure (MAPP) and heart rate (HRV) were recorded in patients with T0, T1, T2, T3 and T4) before and after extubation.The degree of sedation and Ramsay score were recorded when the patient entered and left the anaesthesia.The pain intensity and the score of PACU were recorded on the first day and the third day after operation, and the QoR-40 scale was completed on the third day after operation to evaluate the quality of postoperative recovery.Results: there was no significant difference in general data, operation time, anesthetic time and total amount of opioid use between the two groups.The MAP of right metomidine group was significantly lower than that of T0 group at T 1 and T 2 T 3, but there was no significant difference between the two groups.Before and after extubation, MAPHR of right metoimidine group did not change significantly, but MAPP 0.05 and HRP 0.05) increased significantly in control group.When entering PACU, the Ramsay score of the dexmetomidine group was significantly higher than that of the control group (P 0.05). There was no difference in Ramsay score and VAS score between the two groups at the time of leaving PACU.On the first day after operation, the concentrations of lactate and epinephrine in dexmetomidine group were lower than those before operation and significantly lower than those in control group.The concentration of lactate and norepinephrine in the control group was significantly higher than that in the preoperative group (P 0.05). There was no significant difference in the scores of QoR-40 scale between the two groups on the third day after operation.Conclusion: during orthopedic surgery under general anesthesia, continuous intraoperative injection of 0.4 渭 g/kg/hr dexmetidine can inhibit hemodynamic fluctuations during extubation and inhibit stress response on the first day after operation.There was no significant improvement in the quality of postoperative recovery.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R614

【參考文獻(xiàn)】

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1 孫斌;李南;錢剛;張光明;;右美托咪定對靜吸復(fù)合麻醉患者圍術(shù)期應(yīng)激功能的影響[J];山西醫(yī)科大學(xué)學(xué)報;2011年10期

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本文編號：1741986