本文選題：全身麻醉 + 依托咪酯��； 參考：《南京醫(yī)科大學(xué)》2016年博士論文

【摘要】：[目的]肌陣攣是依托咪酯麻醉誘導(dǎo)過程中常見的不良反應(yīng)。依托咪酯誘發(fā)的肌陣攣通常認(rèn)為是一種驚厥樣發(fā)作。已知激動(dòng)K阿片受體有較強(qiáng)的抗驚厥作用,布托啡諾是作用于K阿片受體臨床常用的藥物。故本研究設(shè)計(jì)為隨機(jī)、雙盲、安慰劑對(duì)照臨床試驗(yàn),其目標(biāo)是論證我們的假設(shè),預(yù)注布托啡諾是否能有效降低依托咪酯誘導(dǎo)的肌陣攣的發(fā)生率和嚴(yán)重程度。[方法]選擇108例ASA分級(jí)為Ⅰ-Ⅱ級(jí),年齡20-65歲,全身麻醉下行擇期手術(shù)的患者。按照由計(jì)算機(jī)產(chǎn)生的隨機(jī)數(shù)字將患者分為兩組,布托啡諾組(B組)和對(duì)照組(S組),每組54例。麻醉誘導(dǎo)靜注依托咪酯0.3mg · kg-1之前2min預(yù)先給布托啡諾0.015mg · kg-1或生理鹽水,給完依托咪酯后持續(xù)觀察2min是否發(fā)生肌陣攣和評(píng)估嚴(yán)重程度。同時(shí)監(jiān)測(cè)患者BP, SpO2, HR及記錄研究期間相關(guān)并發(fā)癥。[結(jié)果]B組7例患者發(fā)生不等程度的肌陣攣,其中輕度3例,中度3例,重度1例。S組有43例發(fā)生肌陣攣,其中輕度7例,中度11例,重度25例。組間比較B組肌陣攣嚴(yán)重程度低于S組(p0.0001),B組肌陣攣發(fā)生率低于S組(13.0%vs 79.6%1 RR=0.163,95%CI：0.081-0.329；χ2=48.265,p0.0001)。在麻醉誘導(dǎo)期間兩組患者的生命體征均平穩(wěn),兩組患者BP, SpO2, HR匕較無差異,兩組患者均未發(fā)現(xiàn)嚴(yán)重的低血壓或心動(dòng)過緩。[結(jié)論]提前2 min預(yù)注0.015 mg/kg布托啡諾可有效降低全麻誘導(dǎo)期間依托咪酯誘發(fā)的肌陣攣的發(fā)生率和嚴(yán)重程度。[目的]地佐辛是國內(nèi)近年得到廣泛應(yīng)用的一種可激動(dòng)K受體的阿片類藥物,它是否與布托啡諾類似,有降低依托瞇醋的肌陣率作用?故本研究也采用隨機(jī)、雙盲、對(duì)照設(shè)計(jì)以評(píng)估地佐辛在全身麻醉誘導(dǎo)期對(duì)依托味醋導(dǎo)致的肌陣攣的影響。[方法]選擇108例ASA分級(jí)為I~II級(jí),年齡20~65歲,全身麻醉下行擇期手術(shù)的患者。按照由計(jì)算機(jī)產(chǎn)生的隨機(jī)數(shù)字將患者分為兩組,地佐辛組(D組)和對(duì)照組(S組),每組54例。麻醉誘導(dǎo)靜注依托瞇酯0.3mg·kg~(-1)之前1min預(yù)先給地佐辛0.1mg·kg~(-1)或生理鹽水,給完依托味醋后持續(xù)觀察2min是否發(fā)生肌陣攣和評(píng)估嚴(yán)重程度。監(jiān)測(cè)患者生命體征及記錄相關(guān)并發(fā)癥。[結(jié)果]D組54例患者中未發(fā)現(xiàn)患者出現(xiàn)肌陣攣(0%),而S組有41例(75.9%)出現(xiàn)不等程度的肌陣攣,其中輕度7例,中度10例,重度24例,組間比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.001)。在麻醉誘導(dǎo)期間兩組患者的生命體征均平穩(wěn),未發(fā)現(xiàn)嚴(yán)重的低血壓和也動(dòng)過緩。[結(jié)論]提前1min預(yù)給0.1mg/kg地佐辛可有效減少全身麻醉誘導(dǎo)期依托咪酯導(dǎo)致的肌陣攣。
[Abstract]:Objective: myoclonus is a common adverse reaction in the induction of etomidate anesthesia. Etomidate-induced myoclonus is usually considered to be a convulsive attack. It is known that activated K opioid receptor has strong anticonvulsant effect. Butorphanol is a commonly used drug acting on K opioid receptor. Therefore, this study was designed as a randomized, double-blind, placebo-controlled clinical trial, with the objective of proving our hypothesis that butorphanol could effectively reduce the incidence and severity of myoclonus induced by etomidate. [methods] 108 patients with ASA grade 鈪，

本文編號(hào)：1934345