本文選題：右美托咪定 + 糖尿病　； 參考：《皖南醫(yī)學院》2017年碩士論文

【摘要】：目的:觀察右美托咪定對2型糖尿病患者全麻誘導期QTc及Tp-e間期的影響,為糖尿病患者麻醉提供臨床參考。方法:60例擬行擇期手術(shù)的2型糖尿病全麻患者,糖尿病病程大于1年,ASA分級Ⅰ~Ⅱ級,年齡40~70歲,體重指數(shù)(BMI)18~30 kg/m2,術(shù)前空腹血糖濃度≤11.2 mmol/L。隨機分為兩組,對照組(C組,n=30)和右美托咪定組(D組,n=30)。D組在麻醉誘導前10分鐘靜脈泵注右美托咪定(DEX)負荷量0.5 ug/kg,之后以0.4 ug·kg-1·h-1持續(xù)泵注至氣管插管后3 min,C組用等劑量生理鹽水以同樣方法泵注。監(jiān)測兩組患者入室靜息后(T0)、誘導后插管前(T1)、插管后1 min(T2)、插管后2 min(T3)及插管后3 min(T4)時兩組患者心率(HR)、平均動脈壓(MAP),記錄并分析心電圖QTc間期及Tp-e間期的變化。結(jié)果:(1)QTc間期及Tp-e間期:與T0比較,D組T1-T4時點QTc間期及Tp-e間期差異無統(tǒng)計學意義(P0.05);C組在T2時點QTc間期顯著延長(P0.05),Tp-e間期在T1及T4時點顯著延長(P0.05)。與C組比較,D組T1、T2及T4時點QTc間期差異有統(tǒng)計學意義(P0.05);D組T1-T4時點Tp-e間期均明顯低于C組(P0.05)。兩組QTc間期及Tp-e間期值均在氣管插管后3 min逐漸恢復到基礎(chǔ)值左右。(2)血流動力學:與T0相比,D組T1、T3及T4時點HR顯著降低,差異有統(tǒng)計學意義(P0.05);D組T1-T4時點MAP均顯著降低(P0.05)。與T1比較,D組T2、T3時點HR顯著升高(P0.05);D組T2-T4時點MAP顯著升高(P0.05)。與T0相比,C組T1、T2及T4時點HR差異有統(tǒng)計學意義(P0.05);C組MAP在T1、T3及T4時點均顯著降低(P0.05)。與T1相比,C組T2-T4時點HR均顯著升高(P0.05);C組T2-T3時點MAP顯著升高(P0.05)。與C組相比,D組T2點HR及MAP均顯著降低,差異有統(tǒng)計學意義(P0.05)。結(jié)論:糖尿病患者全麻誘導期給予右美托咪定能夠有效的抑制患者氣管插管反應,維持血流動力學穩(wěn)定;誘導期使用右美托咪定能夠縮短全麻誘導期的QTc間期及Tp-e間期延長,降低發(fā)生嚴重心律失常的風險。
[Abstract]:Objective: To observe the effect of dexmedetomidin on QTc and Tp-e interval in the induction period of general anesthesia in patients with type 2 diabetes, and to provide clinical reference for the anaesthesia of diabetic patients. Methods: 60 patients with type 2 diabetic general anesthesia which were planned to undergo elective surgery, the course of diabetes was more than 1 years, ASA grade I ~ II, 40~70 years old, BMI 18~30 kg/m2, and preoperative fasting blood. The glucose concentration was less than 11.2 mmol/L. and divided into two groups randomly. The control group (group C, n=30) and right metoimidin group (group D, n=30).D were injected right metodetonidine (DEX) load 0.5 ug/kg for 10 minutes before induction of anesthesia, followed by 0.4 UG kg-1 H-1 continuous pump to 3 min after endotracheal intubation. The group was pumped with equal dose of saline for the same method. Monitoring two Group patients after resting (T0), pre intubation (T1), 1 min (T2) after intubation, 2 min (T3) after intubation and 3 min (T4) after intubation, two groups of patients' heart rate (HR) and mean arterial pressure (MAP), recorded and analyzed the changes in the QTc interval and interval of the ECG. There was no statistical significance (P0.05) in group C (P0.05) at the time point of T2, and a significant extension of Tp-e interval at T1 and T4 time points (P0.05). Compared with the C group, there was a significant difference between the D group T1, the interval and the time point. The interval and interval value of the two groups were both at 3 after endotracheal intubation. Min gradually recovered to the base value. (2) hemodynamic: compared with T0, T1, T3 and T4 at the time point of group D decreased significantly, and the difference was statistically significant (P0.05). The T1-T4 point MAP of D group decreased significantly (P0.05). The difference was statistically significant (P0.05), and the time point of T1, T3 and T4 decreased significantly in group C (P0.05). Compared with T1, T2-T4 point HR increased significantly (P0.05) in C group (P0.05). Imidin can effectively inhibit the patient's tracheal intubation response and maintain hemodynamic stability. The use of dexmedetomidine in the induction period can shorten the QTc interval and Tp-e interval in the induction period of general anesthesia, and reduce the risk of serious arrhythmia.

【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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