本文選題：右旋美托咪定 + 經(jīng)鼻　； 參考：《廣州醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究背景術(shù)前大部分患者存在不同程度的緊張、焦慮，這使患者的應(yīng)激反應(yīng)增強(qiáng)，影響麻醉和手術(shù)的正常進(jìn)行，體內(nèi)交感系統(tǒng)過(guò)度興奮易致心血管不良事件，影響術(shù)后恢復(fù)。因此，術(shù)前使用一些鎮(zhèn)靜抗焦慮藥物是非常必要的。術(shù)前用藥是麻醉的重要組成部分，是麻醉的開(kāi)始，良好的術(shù)前用藥應(yīng)具有鎮(zhèn)靜、抗焦慮、不良反應(yīng)少等優(yōu)點(diǎn)。苯巴比妥鈉作為傳統(tǒng)術(shù)前用藥，它有鎮(zhèn)靜不足、抗焦慮弱等缺點(diǎn)。歐美較多國(guó)家首選咪達(dá)唑侖作為術(shù)前用藥，它在鎮(zhèn)靜、催眠、順行性遺忘等方面均優(yōu)于苯巴比妥鈉。但是，咪達(dá)唑侖伴有抑制呼吸、鎮(zhèn)靜過(guò)度、易誘發(fā)譫妄、使麻醉恢復(fù)期蘇醒時(shí)間延長(zhǎng)等缺點(diǎn)。術(shù)前用藥在無(wú)監(jiān)測(cè)條件下存在一定的安全隱患，并且可能導(dǎo)致蘇醒延遲，從而局限了它的應(yīng)用。 右旋美托咪定（Dexmedetomidine，Dex）是一種高選擇性的α2腎上腺素能受體激動(dòng)藥，它具有鎮(zhèn)靜、抗焦慮、抑制交感神經(jīng)興奮、鎮(zhèn)痛、節(jié)省麻醉藥物和穩(wěn)定血流動(dòng)力學(xué)的作用，臨床劑量對(duì)呼吸抑制輕微。Dex有多種給藥方式，如靜脈注射、肌肉注射、經(jīng)鼻滴注等。靜脈注射Dex對(duì)循環(huán)系統(tǒng)的影響較大，且持續(xù)輸注可能延長(zhǎng)麻醉蘇醒時(shí)間。肌肉注射Dex是有創(chuàng)的，患者的舒適度差，與目前提倡無(wú)創(chuàng)術(shù)前給藥方法相悖，而且肌肉注射的效果比經(jīng)粘膜吸收差。Dex無(wú)色無(wú)味，無(wú)黏膜刺激作用，經(jīng)鼻滴注給藥方便，患者接受度、舒適度好。經(jīng)鼻滴注Dex的起效時(shí)間為30~45min，半衰期為114min，生物利用度為65%，給予足夠的起效時(shí)間，其鎮(zhèn)靜效果與靜注、肌注相當(dāng)。小兒經(jīng)鼻滴注1μg/kg、2μg/kg Dex分別產(chǎn)生53%、66%的滿(mǎn)意鎮(zhèn)靜。經(jīng)鼻滴注Dex使藥物的血漿濃度逐漸緩慢的增加，有可能減弱其對(duì)血壓和心率的影響，從而能保證術(shù)前用藥的安全性。Yuen等研究表明：經(jīng)鼻滴注1μg/kg、1.5μg/kg Dex后沒(méi)有出現(xiàn)高血壓反應(yīng)，在滴鼻后45min血壓（BP）和心率(HR)有適度的降低，但沒(méi)有嚴(yán)重的心動(dòng)過(guò)緩或者心電傳導(dǎo)阻滯出現(xiàn)。因此，經(jīng)鼻滴注Dex作為術(shù)前用藥有一定優(yōu)勢(shì)。目前，經(jīng)鼻滴注Dex作為術(shù)前用藥的相關(guān)研究主要集中于小兒及局麻下行第三磨牙拔除術(shù)的患者，對(duì)于術(shù)前已存在焦慮的成年患者，經(jīng)鼻滴注Dex作為術(shù)前用藥的有效性和安全性的研究甚少。 支撐喉鏡下行聲帶息肉摘除術(shù)用時(shí)短，支撐喉鏡暴露聲門(mén)的操作刺激大，此操作直接刺激會(huì)厭感受器、舌根、頸部肌群深部感受器，引起體內(nèi)兒茶酚胺水平升高，導(dǎo)致血流動(dòng)力學(xué)劇烈波動(dòng)，易致嚴(yán)重的心血管不良反應(yīng)，尤其對(duì)于術(shù)前已患有心腦血管疾病的患者術(shù)中更易并發(fā)心腦血管意外。因此，支撐喉鏡手術(shù)要求麻醉醫(yī)生有效的抑制手術(shù)操作引起的應(yīng)激反應(yīng)，提高圍術(shù)期血流動(dòng)力學(xué)的穩(wěn)定性，提供快速安全的蘇醒。加深麻醉可以抑制手術(shù)操作引起的應(yīng)激反應(yīng)，但是易致患者術(shù)中出現(xiàn)腦電爆發(fā)性抑制、低血壓和麻醉蘇醒延遲。臨床上還將β1受體阻滯劑、鈣離子阻滯劑、糖皮質(zhì)激素等某些非麻醉藥物或局部麻醉藥應(yīng)用于支撐喉鏡手術(shù)的全身麻醉中，從而提高血流動(dòng)力學(xué)的穩(wěn)定性，并能加快蘇醒；但是上述藥物本身不具備鎮(zhèn)靜的作用，卻又抑制了HR和BP的變化；因此增加了判斷患者麻醉深度的困難，使麻醉醫(yī)生忽略可能存在麻醉深度不足的問(wèn)題。 Dex能抑制氣管插管、蘇醒和拔管誘發(fā)的心血管反應(yīng)，使血流動(dòng)力學(xué)更趨穩(wěn)定。研究表明，誘導(dǎo)前靜注單次劑量的Dex能減少麻醉藥用量，提高支撐喉鏡手術(shù)圍術(shù)期血流動(dòng)力學(xué)穩(wěn)定性和蘇醒質(zhì)量。在麻醉恢復(fù)期，Dex能減少惡心嘔吐、寒顫、術(shù)后躁動(dòng)的發(fā)生率，減少患者對(duì)鎮(zhèn)痛藥物的需求，能提高麻醉恢復(fù)質(zhì)量，改善患者對(duì)麻醉的滿(mǎn)意度。因此，Dex在支撐喉鏡手術(shù)麻醉中應(yīng)用有一定優(yōu)勢(shì)。但是，持續(xù)或大劑量的應(yīng)用Dex可能會(huì)造成蘇醒延遲。對(duì)于支撐喉鏡這種短小手術(shù)來(lái)說(shuō)，Dex是否影響麻醉蘇醒時(shí)間是我們需要考慮的問(wèn)題之一。經(jīng)鼻滴注Dex是單次給藥，它使藥物的血漿濃度逐漸緩慢的增加，它用于支撐喉鏡這類(lèi)應(yīng)激反應(yīng)強(qiáng)烈的短小手術(shù)，是否影響麻醉蘇醒時(shí)間以及能否提高血流動(dòng)力學(xué)穩(wěn)定性有待研究。Dex能節(jié)省麻醉藥物，它能降低丙泊酚引起患者意識(shí)消失半數(shù)有效濃度（EC50）。那么，經(jīng)鼻滴注Dex對(duì)丙泊酚引起患者意識(shí)消失時(shí)EC50的影響如何有待研究。 目的1)觀察術(shù)前經(jīng)鼻滴注右旋美托咪定作為術(shù)前用藥的有效性和安全性。2)觀察支撐喉鏡手術(shù)患者術(shù)前經(jīng)鼻滴注右旋美托咪定的麻醉效應(yīng)。3)研究術(shù)前經(jīng)鼻滴注右旋美托咪定對(duì)丙泊酚引起患者意識(shí)消失半數(shù)有效濃度的影響。 第一部分：支撐喉鏡手術(shù)患者術(shù)前經(jīng)鼻滴注右旋美托咪定的可行性研究 目的1)觀察術(shù)前經(jīng)鼻滴注右旋美托咪定作為術(shù)前用藥的有效性和安全性。2)觀察支撐喉鏡手術(shù)患者術(shù)前經(jīng)鼻滴注右旋美托咪定的麻醉效應(yīng)。 方法80例擇期行支撐喉鏡下聲帶息肉摘除術(shù)的成年患者隨機(jī)分為兩組，，分別為D組和N組。D組在麻醉前45~60min經(jīng)鼻滴注Dex1μg/kg，N組經(jīng)鼻滴注0.9%生理鹽水。麻醉誘導(dǎo)：患者均行丙泊酚靶控輸注（Target-controlled Infusion, TCI），初始血漿靶控輸注濃度為2.5μg/mL，調(diào)節(jié)丙泊酚靶濃度，每次增減0.5μg/mL維持2min直至Narcotrend指數(shù)（Narcotrend Index, NI）值維持在“D0”~“E1”水平（NI：64~20）并保持到手術(shù)結(jié)束；然后行瑞芬太尼TCI，初始效應(yīng)室濃度設(shè)為3.0ng/mL；意識(shí)喪失后，靜注羅庫(kù)溴銨0.9mg/kg；60s后氣管插管行機(jī)械通氣。術(shù)中通過(guò)調(diào)節(jié)丙泊酚的靶濃度維持NI于“D0”~“E1”水平，調(diào)節(jié)瑞芬太尼效應(yīng)室濃度維持SBP升高和降低幅度不超過(guò)基礎(chǔ)值的25%，HR90bpm。記錄滴鼻前后HR、BP、脈搏氧飽和度(SpO2)、改良警覺(jué)/鎮(zhèn)靜評(píng)分（OAA/S）和焦慮評(píng)分；記錄蘇醒拔管時(shí)間；記錄NI達(dá)“D0”水平、置入支撐喉鏡前、退出支撐喉鏡時(shí)的丙泊酚效應(yīng)室濃度，記錄置入支撐喉鏡前、置入支撐喉鏡即刻、退出支撐喉鏡時(shí)的瑞芬太尼效應(yīng)室濃度，記錄恢復(fù)自主呼吸、蘇醒時(shí)和拔管時(shí)的丙泊酚和瑞芬太尼效應(yīng)室濃度；記錄觀察期不良事件的發(fā)生情況和患者對(duì)麻醉的滿(mǎn)意度。 結(jié)果 1、一般情況 兩組一般情況比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 2、滴鼻前、入室時(shí)、誘導(dǎo)前三個(gè)時(shí)點(diǎn)的鎮(zhèn)靜和焦慮評(píng)分的變化 誘導(dǎo)前，D組的OAA/S和焦慮評(píng)分分別為4.58±0.12和3.30±0.08，N組的OAA/S和焦慮評(píng)分分別為5.60±0.10和2.85±0.10，D組的OAA/S低于N組，D組的焦慮評(píng)分高于N組（P0.05）。在D組內(nèi)，誘導(dǎo)前OAA/S低于滴鼻前，焦慮評(píng)分高于滴鼻前（P0.05）。 3、滴鼻前、入室時(shí)、誘導(dǎo)前三個(gè)時(shí)點(diǎn)的HR、BP、SpO2的變化 誘導(dǎo)前，D組的HR比N組低8.84%（P0.05）。在D組內(nèi)，與滴鼻前相比，入室時(shí)HR下降6.72%，誘導(dǎo)前HR下降8.53%（P0.05）。三個(gè)時(shí)點(diǎn)，兩組的SBP比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。在N組內(nèi)，入室時(shí)和誘導(dǎo)前的SBP、DBP高于滴鼻前（P0.05）。在D組內(nèi)，入室時(shí)和滴鼻前、誘導(dǎo)前和滴鼻前比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。所有患者的SpO2都沒(méi)有低于95%。 4、丙泊酚和瑞芬太尼效應(yīng)室濃度 在置入支撐喉鏡前，D組的丙泊酚效應(yīng)室濃度比N組低7.3%（P0.05）。在置入支撐喉鏡前、置入支撐喉鏡即刻、退出支撐喉鏡時(shí)、恢復(fù)自主呼吸時(shí)、蘇醒時(shí)和拔管時(shí)，D組的瑞芬太尼效應(yīng)室濃度均低于N組（P0.05）。 5、滴鼻至入室時(shí)間、滴鼻至誘導(dǎo)前時(shí)間、麻醉時(shí)間、手術(shù)時(shí)間、恢復(fù)自主呼吸時(shí)間、蘇醒時(shí)間和拔管時(shí)間 兩組的滴鼻至入室時(shí)間、滴鼻至誘導(dǎo)前時(shí)間、麻醉時(shí)間、手術(shù)時(shí)間、恢復(fù)自主呼吸時(shí)間、蘇醒時(shí)間和拔管時(shí)間比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 6、觀察期心血管不良事件的發(fā)生情況 麻醉恢復(fù)期，N組和D組出現(xiàn)心動(dòng)過(guò)速的患者例數(shù)分別為8例和2例，出現(xiàn)高血壓的患者例數(shù)分別為14例和5例，N組心動(dòng)過(guò)速和高血壓的發(fā)生率高于D組（P0.05）。 7、觀察期其它不良事件的發(fā)生情況 N組和D組麻醉恢復(fù)期寒戰(zhàn)、惡心嘔吐、呼吸抑制的發(fā)生情況比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 8、患者對(duì)麻醉的滿(mǎn)意度 D組對(duì)麻醉滿(mǎn)意的患者比例高于N組（D組為36例，N組為23例）（P0.05）。 結(jié)論術(shù)前經(jīng)鼻滴注右旋美托咪定1μg/kg應(yīng)用于支撐喉鏡手術(shù)能產(chǎn)生有效的鎮(zhèn)靜抗焦慮作用，對(duì)HR、SpO2、BP影響輕微，作為術(shù)前用藥具有一定的有效性和安全性。它能降低丙泊酚和瑞芬太尼效應(yīng)室濃度，不影響蘇醒、拔管時(shí)間，提高麻醉恢復(fù)期血流動(dòng)力學(xué)穩(wěn)定性，提高了麻醉復(fù)蘇質(zhì)量。 第二部分：術(shù)前經(jīng)鼻滴注右旋美托咪定對(duì)丙泊酚引起患者意識(shí)消失半數(shù)有效濃度的影響 目的術(shù)前經(jīng)鼻滴注右旋美托咪定對(duì)丙泊酚引起患者意識(shí)消失半數(shù)有效濃度的影響。 方法24例擇期行頭頸部手術(shù)的患者于麻醉前45~60min經(jīng)鼻滴注Dex1μg/kg。丙泊酚TCI，設(shè)其初始血漿靶控輸注濃度(Cp)為2.0μg/ml，待Cp與丙泊酚效應(yīng)室濃度（Ce）達(dá)平衡時(shí)，觀察患者意識(shí)是否消失，意識(shí)消失的標(biāo)準(zhǔn)為呼之不睜眼，睫毛反射消失。若上一例患者意識(shí)消失，則下一例患者Cp下調(diào)0.2μg/ml，反之，則上調(diào)0.2μg/ml。制作出意識(shí)消失分布示意圖，待出現(xiàn)6個(gè)陰陽(yáng)拐點(diǎn)后，結(jié)束研究。記錄每例患者意識(shí)消失與否，記錄Cp和Ce達(dá)平衡的時(shí)間。 結(jié)果經(jīng)鼻滴注Dex后丙泊酚引起患者意識(shí)消失時(shí)的EC50為1.38μg/ml，EC50的95％CI為1.373~1.395μg/ml。丙泊酚Cp和Ce達(dá)平衡的時(shí)間為13.21±0.72min。 結(jié)論術(shù)前經(jīng)鼻滴注右旋美托咪定1μg/kg后丙泊酚引起患者意識(shí)消失時(shí)的EC50為1.38μg/ml，EC50的95％CI為1.373~1.395μg/ml。
[Abstract]:In the study background, most patients have different degrees of tension and anxiety. This makes the patient's stress response enhanced, which affects the normal operation of anesthesia and surgery. The hyperexcitability of the sympathetic system in the body causes adverse cardiovascular events and affects the postoperative recovery. Therefore, it is necessary to use some sedative and anti anxiety drugs before operation. An important part of drunken is the beginning of anaesthesia. Good premedication should be composed of sedative, anti anxiety, and less adverse reactions. As a traditional premedication, phenobarbital has shortcomings such as lack of sedative and weak anxiety. Midazolam is the first choice in many countries in Europe and America. It is used in the aspects of sedative, hypnotic, and amnesia. It is superior to phenobarbital sodium. However, midazolam is associated with inhibition of breathing, excessive sedation, delirium easily induced and prolonged awakening in the recovery period. Preoperative medication has a certain safety hazard under no monitoring conditions, and may lead to a delay in revival, thus limiting its application.
Dexmedetomidine (Dex) is a highly selective alpha 2 adrenergic receptor agonist. It has a sedative, anti anxiety, analgesic, analgesic, analgesic, anaesthetized and hemodynamic role. The clinical dose has a variety of drug delivery methods for breathing inhibition of light.Dex, such as intravenous injection, intramuscular injection. Intravenous injection of Dex has a great influence on the circulation system, and continuous infusion may prolong the time of awakening. The intramuscular injection of Dex is invasive and the patient's comfort is poor, and it is contrary to the current method of advocating noninvasive surgery, and the effect of intramuscular injection is colorless and tasteless than mucous absorption of.Dex. It is convenient to take the medicine, the patient's acceptance and comfort are good. The onset time of Dex is 30~45min, the half-life is 114mIn, the bioavailability is 65%, the effective time is given, the sedative effect and the static injection are equal. The children transnasal infusion 1 mu g/kg, 2 mu g/kg Dex produce 53%, 66% satisfactory sedation respectively. Via nasal drip Dex to make the drug plasma The gradual slow increase in concentration may weaken its effect on blood pressure and heart rate, thus ensuring the safety of preoperatively, such as the safety of.Yuen, and other studies suggest that there is no hypertension response after a nasal drip of 1 g/kg, 1.5 g/kg Dex, and a moderate decrease in 45min blood pressure (BP) and heart rate (HR) after the nose drops, but there is no serious bradycardia or heart. Electrical conduction block appears. Therefore, Dex as a premedication has some advantages. At present, the related research on the use of Dex as a preoperation is mainly focused on the patients with third molar extraction under children and local anesthesia. The efficacy and safety of Dex infusion through nasal drip for preoperatively in adult patients who have been anxious before operation There is little research on sex.
The operation of the laryngoscope is short, and the operation of the laryngoscope exposes the glottis greatly. This operation directly stimulates the epiglottis, the tongue root, the deep receptor of the neck muscle, causes the increase of the level of the catecholamine in the body, causes the severe fluctuation of the hemodynamics, and causes the serious cardiovascular adverse reactions, especially for the preoperation. Patients with cardiovascular and cerebrovascular diseases are more likely to be associated with cardiovascular and cerebrovascular accidents. Therefore, the support laryngoscopy requires the anesthesiologist to effectively inhibit the stress response caused by the operation, improve the stability of the perioperative hemodynamics, and provide a rapid and safe revival. During the operation of the patients, the patients with electroencephalogram, hypotension, and anesthesia are delayed. Some non anesthetic or local anesthetics, such as beta 1 receptor blockers, calcium ion blockers, glucocorticoids, or local anesthetics, are also used in general anesthesia supporting the laryngoscope operation to improve the stability of hemodynamics and accelerate recovery. The drug itself does not have a sedative effect, but it also inhibits the changes in HR and BP, and thus increases the difficulty of judging the depth of the anesthetic, allowing the anesthesiologist to ignore the possibility of a lack of depth of anesthesia.
Dex can inhibit endotracheal intubation, revive and extubate the cardiovascular response, and make hemodynamics more stable. The study shows that the pre induction of a single dose of Dex can reduce the dosage of anesthetics and improve the hemodynamic stability and revival quality during the perioperative period of laryngoscopy, and Dex can reduce nausea, vomiting, chill, and postoperative chill in the recovery period of drunken laryngoscope. The incidence of agitation, reducing the patient's demand for analgesics, improving the quality of the anesthetic recovery and improving the patient's satisfaction with the anesthetic. Therefore, Dex has a certain advantage in the application of the support for laryngoscopy anesthesia. However, a sustained or large dose of Dex may cause a waking delay. For the short operation of the prop laryngoscope, Dex The effect of the anesthesia recovery time is one of the problems we need to consider. The transnasal infusion of Dex is a single dose, which makes the plasma concentration of the drug slowly increasing. It is used to support the short operation of stress reaction such as laryngoscope. Whether it affects the time of anesthesia recovery and whether to raise the stability of hemodynamics needs to be studied by.Dex. Narcotic drugs, which can reduce the median effective concentration (EC50) of the patient's disappearance of propofol, and how the effect of Dex on EC50 when propofol causes the disappearance of the patient's consciousness remains to be studied.
Objective 1) to observe the efficacy and safety of dexmedetomidine before operation as the efficacy and safety of dexmedetomidine (.2) to observe the effect of dexmedetomidine (dexmedetomidine) by dripping dexmeimidine (dexmedetomidine) before operation for patients with prop laryngoscope surgery (.3).
Part one: feasibility study of preoperative dexmedetomidine instillation via self retaining laryngoscope surgery.
Objective 1) to observe the efficacy and safety of dexmedetomidine (.2) before operation and observe the anesthetic effect of dexmedetomidine on the patients undergoing laryngoscope surgery.
Methods 80 adult patients undergoing elective laryngoscope vocal cord polyps were randomly divided into two groups: group D and group N, group.D, 45~60min via nasal drip Dex1 mu g/kg before anesthesia, and 0.9% physiological saline infusion through nasal drip in group N. The patients were induced by target controlled infusion of propofol (Target-controlled Infusion, TCI), and initial plasma target controlled infusion. The concentration was 2.5 mu g/mL, the target concentration of propofol was adjusted, and the Narcotrend index (Narcotrend Index, NI) was maintained at the level of "D0" ~ "E1" (NI:64~20) and kept to the end of the operation, and the value of Narcotrend Index, NI was maintained at the level of "D0" ~ "E1" (NI:64~20), and the initial effect chamber concentration was set to 3.0ng/mL; after the loss of consciousness, the Narcotrend was injected with rocuronium. After 60s, the endotracheal intubation was ventilated by mechanical ventilation. During the operation, the target concentration of propofol was maintained to maintain NI at "D0" ~ "E1" level, and the concentration of remifentanil effect room was adjusted to maintain the increase and decrease of SBP by 25%. HR90bpm. recorded HR, BP, pulse oxygen saturation (SpO2), improved vigilance / sedation score (OAA/S) and anxiety before and after the nose drops. Score; record the awakening and extubation time; record the level of NI up to "D0", withdraw the propofol effect room concentration before the supporting laryngoscope, record the concentration of the propofol effect room before the supporting laryngoscope, record the remifentanil effect room concentration in the support laryngoscope immediately, withdraw the remifentanil effect room concentration in the support laryngoscope, record the spontaneous breathing, the propofol and the propofol at the time of awakening and extubation. The concentration of remifentanil effect chamber was recorded, and the occurrence of adverse events during observation period and the satisfaction degree of patients to anesthesia were recorded.
Result
1, general situation
There was no significant difference between the two groups in general condition (P0.05).
2, the change of sedation and anxiety scores at the three points before induction.
Before induction, the scores of OAA/S and anxiety in group D were 4.58 + 0.12 and 3.30 + 0.08 respectively. The OAA/S and anxiety scores in group N were 5.60 + 0.10 and 2.85 + 0.10 respectively. The OAA/S in D group was lower than that in the N group. The anxiety score in D group was higher than that in the N group (P0.05).
3, the changes of HR, BP and SpO2 at the three points before induction.
Before induction, the HR in the D group was 8.84% lower than that in the N group (P0.05). In the D group, the HR decreased by 6.72% and 8.53% (P0.05) before the induction. The two groups of SBP were not statistically significant (P0.05) at the three time points. In the N group, the admission and pre induction SBP were higher than that before the nose drops. There was no significant difference between the two groups (P0.05). The SpO2 of all patients was not lower than 95%..
4, propofol and remifentanil effect chamber concentration
The propofol effect chamber concentration in group D was 7.3% lower than that of the N group before placing the support laryngoscope. The concentration of remifentanil effect room in group D was lower than that of the N group (P0.05) when the supporting laryngoscope was placed immediately before the prop laryngoscope was placed, and when the support laryngoscope was exited, and the spontaneous breathing was restored. The concentration of remifentanil effect room in group D was lower than that of the N group (P0.05).
5, the time from nose to room, nose to induction time, anesthesia time, operation time, recovery of spontaneous breathing time, recovery time and extubation time.
There was no significant difference between the two groups of intranasal time, the time of intranasal to pre induction, the time of anesthesia, the time of operation, the recovery of the time of spontaneous breathing, the time of awakening and the time of extubation (P0.05).
6, the occurrence of adverse cardiovascular events during the observation period
The number of patients with tachycardia in group N and group D was 8 and 2, respectively. The number of patients with hypertension was 14 and 5 respectively. The incidence of tachycardia and hypertension in group N was higher than that in group D (P0.05).
7, the occurrence of other adverse events during the observation period
There was no significant difference in the incidence of chills, nausea and vomiting and respiratory depression between group N and group D (P0.05).
8, patients' satisfaction with anesthesia
Patients in group D were more satisfied with anesthesia than those in group N (group D was 36 cases and group N was 23 cases) (P0.05).
Conclusion the application of dexmedetomidine 1 g/kg to prop laryngoscopy before operation can produce effective sedative and anti anxiety effect and slight effect on HR, SpO2, BP. It has certain efficacy and safety as preoperatively. It can reduce the concentration of propofol and remifentanil effect room, do not affect recovery, extubation time, and improve the recovery period of anesthesia. The stability of hemodynamics improved the quality of anesthesia recovery.
The second part: the influence of dexmedetomidine on the half effective concentration of propofol induced disconsciousness.
Objective to investigate the effect of dexmedetomidine on the effective half of effective concentration of propofol.
Methods 24 patients undergoing selective head and neck surgery were instilled Dex1 mu g/kg. propofol TCI before anaesthesia. The initial plasma target controlled infusion concentration (Cp) was 2 g/ml, and when the Cp and propofol effect chamber concentration (Ce) reached balance, the consciousness disappeared, the standard of consciousness disappeared and the eyelash reflex disappeared. In one case, the patient's consciousness disappeared, then the next patient Cp was down 0.2 mu g/ml, and on the contrary, the consciousness disappeared distribution map was made up by 0.2 mu g/ml.. After the emergence of 6 Yin and Yang points, the study ended. Record the time for the balance of Cp and Ce to record the disappearance of each patient's consciousness.
Results the EC50 of propofol caused by propofol after Dex was 1.38 mu g/ml, and the 95%CI of EC50 was 13.21 + 0.72min. for 1.373~1.395 g/ml. propofol Cp and Ce.
Conclusion propofol can induce the loss of consciousness in patients with 1.38 EC50 g/ml after intravenous drip of dexmedetomidine 1 micronutre before surgery, and the 95%CI of EC50 is 1.373~1.395 g/ml. g/kg.

【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R614.2

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