本文選題：右美托咪定 + 高血壓��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：背景：高血壓是多種心、腦血管疾病的重要病因和危險因素，影響重要臟器，如心、腦、腎的結(jié)構(gòu)與功能，，根據(jù)其分類可將高血壓分為原發(fā)性高血壓和繼發(fā)性高血壓兩大類，通常所說的高血壓是指原發(fā)性高血壓（primary hypertension），其是指以血壓升高為主要臨床表現(xiàn)伴或不伴有多種心血管危險因素的綜合征�；加懈哐獕旱幕颊咴谌砺樽砘謴�(fù)期氣管拔管階段易發(fā)生血壓劇烈波動，從而導(dǎo)致圍手術(shù)期心腦血管意外的發(fā)生，增加麻醉的相關(guān)風(fēng)險。因此，對于高血壓的患者來說，如果想要保證患者的生病安全，必須維持麻醉蘇醒期間血流動力學(xué)的相對穩(wěn)定。右美托咪定(dexmedetomidine，DEX)的出現(xiàn)給患者帶來了福音，其是一種新型的α2腎上腺素受體激動劑，具有高度特異性、高選擇性；具有催眠、抗焦慮、鎮(zhèn)靜、抗交感、鎮(zhèn)痛效應(yīng)，同時更因其無呼吸抑制、穩(wěn)定的血流動力學(xué)以及其獨特的可喚醒效應(yīng)，被廣泛應(yīng)用于臨床。 目的：觀察右美托咪定應(yīng)用于靜脈麻醉對高血壓病人恢復(fù)期的影響并指導(dǎo)臨床用藥。 方法：選擇高血壓I-II級，擬在全麻下?lián)衿谑中g(shù)病人60例，隨機分為二組：丙泊酚組（C組）和右美托咪定組（D）組，每組各30例。C組和D組均吸入七氟醚1.8%-2%，同時C組采用微量泵輸入丙泊酚2～3mg/（kg·h）和瑞芬太尼2～4μg/（kg·h），D組采用微量泵輸入右美托咪定和瑞芬太尼2～4μg/（kg·h），右美托咪定以1μg/kg輸注10min后用0.2～0.7μg/kg/h持續(xù)輸注，兩組患者均在手術(shù)縫皮結(jié)束時停藥，監(jiān)測手術(shù)結(jié)束至拔管后10min的血流動力學(xué)指標(biāo)，鎮(zhèn)痛評分及躁動情況。 結(jié)果:兩組患者的一般資料無顯著性差異。接受DxM治療的患者在全麻恢復(fù)期血流動力學(xué)穩(wěn)定、鎮(zhèn)痛良好和無躁動發(fā)生。 結(jié)論： 1、右美托咪定可以應(yīng)用于靜脈麻醉。 2、右美托咪定有利于維持血流動力學(xué)的穩(wěn)定，減少心腦血管事件的發(fā)生。
[Abstract]:Background: hypertension is an important etiology and risk factor for many kinds of heart and cerebrovascular diseases. It affects the structure and function of important organs, such as heart, brain and kidney. According to its classification, hypertension can be divided into two categories: essential hypertension and secondary hypertension. Hypertension is usually referred to as primary hypertensionation of essential hypertension, which refers to syndrome with or without multiple cardiovascular risk factors with elevated blood pressure as the main clinical manifestation. Patients with hypertension are prone to severe fluctuation of blood pressure in the stage of tracheal extubation during the convalescent stage of general anesthesia, which leads to the occurrence of perioperative cardio-cerebrovascular accidents and increases the risk of anesthesia. Therefore, for patients with hypertension, hemodynamic stability during anaesthesia recovery must be maintained if the patient is to be safe from illness. The advent of dexmemedetomine (DEX) is a new type of 偽 2-adrenergic agonist with high specificity and selectivity, hypnosis, anti-anxiety, sedation, anti-sympathetic and analgesic effects. At the same time, it is widely used in clinic because of its no respiratory inhibition, stable hemodynamics and its unique arousal effect. Aim: to observe the effect of dexmetomidine on the recovery of hypertensive patients and to guide the clinical use of dexmetomidine. Methods: sixty patients with I-II grade hypertension were randomly divided into two groups: propofol group (group C) and dexmetomidine group (group D). Each group (n = 30) and group D (n = 30) were inhaled with sevoflurane 1.8-2, and group C received intravenous infusion of propofol (2~3mg/(kg h) and remifentanil (2 渭 g/(kg / h) respectively. Dextromidine and remifentanil (24 渭 g/(kg / h) were injected continuously with 10min at 1 渭 g/kg. The hemodynamic indexes, analgesic scores and restlessness of 10min were monitored at the end of suture skin operation in both groups. Results: there was no significant difference in general data between the two groups. Patients treated with DxM had stable hemodynamics, good analgesia and no restlessness during general anesthesia recovery. Conclusion: 1. Dexmetomidine can be used in intravenous anesthesia. 2, dexmetomidine is beneficial to maintain hemodynamic stability and reduce the occurrence of cardiovascular and cerebrovascular events.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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本文編號：1979725