本文選題：喚醒麻醉 + 氟芬合劑　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的比較右美托咪啶與氟芬合劑在功能區(qū)腦膠質(zhì)瘤切除術(shù)術(shù)中喚醒期的效果,為術(shù)中喚醒麻醉藥物選擇提供科學(xué)依據(jù)。方法選擇40例擬行功能區(qū)腦膠質(zhì)瘤切除聯(lián)合術(shù)中喚醒術(shù)患者,術(shù)中需喚醒以確定大腦皮層功能區(qū)位置,隨機(jī)分為右美托咪啶組(D組)與氟芬合劑組(F組),每組20例。兩組均以丙泊酚,瑞芬太尼全麻誘導(dǎo),行喉罩控制通氣。在進(jìn)行電生理監(jiān)測(cè)前15 min停止丙泊酚、瑞芬太尼輸注,F組以芬太尼100ug,氟哌利多5mg負(fù)荷劑量泵注30min,之后以芬太尼100ug/h,氟哌利多5mg/h持續(xù)泵注維持;D組靜脈注射右美托咪啶負(fù)荷劑量0.5ug/kg,之后以右美托咪啶0.3ug/kg/h-0.5ug/kg/h持續(xù)輸注維持。待患者自主呼吸恢復(fù)以后,拔出喉罩。腫瘤切除后,再次行麻醉誘導(dǎo)置入喉罩,持續(xù)輸注丙泊酚,瑞芬太尼,直至手術(shù)結(jié)束。本實(shí)驗(yàn)主要觀察指標(biāo)為喚醒期警覺(jué)/鎮(zhèn)靜評(píng)分、疼痛數(shù)字評(píng)分、腦功能區(qū)定位時(shí)態(tài)評(píng)分,喚醒時(shí)間,觀察患者術(shù)中呼吸抑制、惡心嘔吐、躁動(dòng)、寒戰(zhàn)等不良反應(yīng)發(fā)生情況。術(shù)中生命體征觀察的時(shí)間點(diǎn)為:基礎(chǔ)值(T0)、停止輸注丙泊酚即刻(T1)、喚醒即刻(T2)、喚醒后5min(T3)、喚醒后10min(T4)、喚醒后15min(T5)、喚醒后30min(T6)、喚醒后60min(T7)。記錄各個(gè)時(shí)點(diǎn)的MAP、HR、SpO2。采用SPSS19.0軟件進(jìn)行數(shù)據(jù)處理,計(jì)量資料以均數(shù)士標(biāo)準(zhǔn)差形式表示,采取兩獨(dú)立樣本t檢驗(yàn);計(jì)數(shù)資料以百分比表示,使用卡方檢驗(yàn);術(shù)中各評(píng)分結(jié)果采用秩和檢驗(yàn),P0.05時(shí)差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.兩組患者性別、年齡、身高、體重、體重指數(shù)差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.右美托咪啶組喚醒期血壓,心率,喚醒時(shí)間顯著低于氟芬合劑組(P0.05)。3.警覺(jué)/鎮(zhèn)靜評(píng)分,疼痛數(shù)字評(píng)分,腦功能區(qū)定位時(shí)態(tài)評(píng)分得分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.右美托咪啶組3例患者出現(xiàn)惡心,氟芬合劑組1例患者出現(xiàn)呼吸抑制,不良事件發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),兩組患者均未發(fā)生躁動(dòng)、寒戰(zhàn)。結(jié)論1.右美托咪啶與氟芬合劑均能成功用于功能區(qū)腦膠質(zhì)瘤切除術(shù)術(shù)中喚醒麻醉。2.右美托咪啶組喚醒時(shí)間短,術(shù)中喚醒期間血流動(dòng)力學(xué)更穩(wěn)定。
[Abstract]:Objective to compare the arousal effect of dexmetidine and flufen mixture in functional area glioma resection, and to provide scientific basis for the choice of anesthetic drugs. Methods Forty patients with functional glioma resection combined with intraoperative arousal were randomly divided into group D (group D) and group F (n = 20 in each group). Both groups were induced by general anesthesia with propofol and remifentanil and were treated with laryngeal mask controlled ventilation. Propofol was stopped 15 min before electrophysiological monitoring. Remifentanil was injected with fentanyl 100ug, droperidol 5mg loading dose pump for 30 mins, then fentanyl 100ugrhh. droperidol 5mg/h continued to be injected intravenously with dexmetimetidine at a loading dose of 0.5 g / kg, and then was maintained with dexmetidine 0.3ug/kg/h-0.5ug/kg/h. After the patient regains his own breathing, pull out the laryngeal mask. After tumor resection, the larynx mask was induced again by anesthesia and continued infusion of propofol and remifentanil until the end of the operation. The main indexes of this experiment were arousal alarm / sedation score, pain number score, brain functional area localization tense score, arousal time, and observe the occurrence of adverse reactions during operation, such as respiratory depression, nausea and vomiting, restlessness, shivering and so on. The observation time points of vital signs during the operation were as follows: the basic value was T _ 0, the infusion of propofol was stopped immediately, the T _ (2) T _ (2) was awakened immediately, the T _ (3) was activated at 5 min, the T _ (4) was 10 min after arousal, the T _ (5) was 15 min after arousal, the time was 30 min after arousal, and 60 min T _ (7) after arousal. MAPHR-SPO _ 2. SPSS19.0 software was used to process the data, the measurement data was expressed in the form of standard deviation of mean number, and two independent samples t-test were adopted, the counting data was expressed as percentage and chi-square test was used. There was a significant difference in the results of intraoperative scoring with rank sum test (P 0.05). Result 1. The gender, age, height and body mass index of the two groups were not significantly different (P < 0.05). The blood pressure, heart rate and arousal time of dexmetidine group were significantly lower than that of fluphene mixture group (P 0.05N. 3). There was no significant difference in the scores of alertness / sedation score, pain number score and brain functional area localization tense score (P 0.05). 4. There were 3 cases of nausea in dexmetidine group and 1 case of respiratory depression in flufen mixture group. There was no significant difference in the incidence of adverse events between the two groups (P 0.05). There was no restlessness and shivering in both groups. Conclusion 1. Both dexmetidine and flufenac can be successfully used in arousal anesthesia. 2. The wakeup time of dexmetidine group was shorter and hemodynamics was more stable during intraoperative arousal.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R614

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