本文選題：右美托咪定 + 甲狀腺手術�。� 參考：《重慶醫(yī)科大學》2017年碩士論文

【摘要】：目的探討右美托咪定(Dexmedetomidine,DEX)對甲狀腺手術患者全麻恢復期間嗆咳反應及術后恢復情況的影響。方法納入2015年12月至2016年6月在我院行甲狀腺腫瘤手術的患者為研究對象,選擇年齡18~64歲,BMI 18~30kg/m~2,ASA分級Ⅲ級以下的患者118例,隨機分為兩組:右美托咪定組和生理鹽水組,前者在手術開始時持續(xù)靜脈泵注右美托咪定0.4μg·kg~（-1）·h~（-1）至手術結束;后者則給予等容量的0.9%生理鹽水。所有患者術前常規(guī)禁飲禁食;0.5mg阿托品和25mg異丙嗪為術前用藥。手術開始時右美托咪定組持續(xù)靜脈泵注右美托咪定0.4μg·kg~（-1）·h~（-1）至手術結束,生理鹽水組則持續(xù)靜脈泵注等容量的0.9%生理鹽水至手術結束。觀察兩組患者全麻恢復期間嗆咳反應情況;記錄所有患者術后第一個24h及第二個24h切口引流量;記錄麻醉誘導前(T0)、手術結束時(T1)、拔管前吸痰時(T2)、拔管時(T3)、拔管后5 min(T4)、10 min(T5)及15 min(T6)的MAP和HR變化;記錄患者手術時間、麻醉時間、麻醉藥用量、自主呼吸恢復時間、氣管拔管時間、PACU停留時間及不良反應發(fā)生情況;使用QOR-40評分量表(40-item quality of recovery sowing system)評估兩組患者術前、術后24h、術后48h、術后3個月、術后6個月時恢復質量;記錄患者術后出血情況、切口愈合等級、術后住院時間、患者滿意度;術后3、6個月時通過患者門診隨訪及對其電話隨訪,收集腫瘤轉移及復發(fā)情況。結果兩組患者一般資料各指標(性別構成比、年齡、BMI、ASA分級構成比、高血壓病史、糖尿病病史、手術時間、麻醉時間、術中冰凍結果、術前QOR-40評分總分)比較差異無統(tǒng)計學意義(P0.05)。與C組相比,D組全麻恢復期間嗆咳發(fā)生率及嗆咳強度降低,主要表現(xiàn)在帶氣管導管時,帶管吸痰時和拔管時(P0.05);D組術后第一、二個24h引流量較C組減少(P0.05);與C組比較,D組T2~4時HR及MAP顯著降低,圍術期心動過速發(fā)生率降低(P0.05);D組丙泊酚、瑞芬太尼用量較C組減少(P0.05);與C組比較,D組術后24h的QOR-40評分較高,主要體現(xiàn)在情緒狀態(tài)、身體舒適度、疼痛方面(P0.05);與C組比較,D組患者住院期間滿意度較高;兩組患者自主呼吸恢復時間、氣管拔管時間、PACU停留時間、術后住院時間比較差異無統(tǒng)計學意義(P0.05)。兩組患者切口愈合情況比較差異無統(tǒng)計學意義(P0.05)。兩組患者術后3個月、6個月時QOR-40評分、滿意度、腫瘤轉移及復發(fā)情況比較差異無統(tǒng)計學意義(P0.05)。結論(1)術中持續(xù)輸注0.4μg·kg~（-1）·h~（-1）劑量的右美托咪定能夠有效減輕甲狀腺手術患者全麻恢復期間的嗆咳反應,具有良好的安全性;(2)術中持續(xù)輸注0.4μg·kg~（-1）·h~（-1）劑量的右美托咪定能夠維持甲狀腺手術患者圍術期血流動力學穩(wěn)定,降低患者術后出血的風險,改善患者的早期恢復質量,對患者的遠期術后恢復無影響。
[Abstract]:Objective to investigate the effect of Dexmedetomine Dex on cough response and postoperative recovery during general anesthesia recovery in patients undergoing thyroid surgery. Methods from December 2015 to June 2016, 118 patients who underwent thyroid tumor surgery in our hospital were randomly divided into two groups: dexmetomidine group and normal saline group. The former received intravenous infusion of dexmetomidine 0.4 渭 g kg-1) to the end of the operation at the beginning of operation, while the latter was given 0.9% saline of equal volume. All patients were routinely prohibited from drinking and fasting 0.5 mg atropine and 25mg promethazine before operation. At the beginning of operation, dexmetomidine group was continuously injected with dexmetomidine 0.4 渭 g kg 路kg ~ (-1) h ~ (-1) to the end of the operation, while in the saline group, 0.9% saline of the same volume was continuously injected to the end of the operation. The response of choking cough during the recovery of general anesthesia was observed in both groups, and the drainage flow of the first 24 hours and the second 24 hours after operation were recorded in all the patients. The changes of map and HR were recorded before anesthesia induction, at the end of operation, during sputum aspiration before extubation, during extubation, 5 min after extubation, 10 min T5 and 15 min T6), and the time of operation, dosage of anesthetic, recovery time of spontaneous respiration were recorded. Using QOR-40 score scale 40-item quality of recovery sowing system) to evaluate the quality of patients before, 24 hours, 48 hours, 3 months and 6 months after operation, and to record the bleeding after operation. The grade of wound healing, postoperative hospitalization time, patient satisfaction, and tumor metastasis and recurrence were collected by outpatient follow-up and telephone follow-up at 3 and 6 months after operation. Results there was no significant difference between the two groups in general data (sex composition ratio, age BMI-ASA grading ratio, history of hypertension, history of diabetes, operation time, anesthetic time, intraoperative freezing result, total score of QOR-40 score before operation). Compared with group C, the incidence of cough and the intensity of cough in group D were decreased during the recovery of general anesthesia. Compared with C group, HR and map in group D decreased significantly, the incidence of cardiac tachycardia in group C decreased during operation period, propofol and remifentanil dosage decreased compared with group C, and QOR-40 score in group D was higher than that in group C at 24 hours after operation, and the volume of remifentanil in group C was significantly lower than that in group C (P < 0.05), and the score of QOR-40 in group D was higher than that in group C (P < 0.05). Compared with group C, the satisfaction of group D was higher than that of group C; the time of spontaneous respiratory recovery and extubation of trachea and tracheal extubation and the duration of PACU stay were higher in group D than in group C, and were mainly reflected in their emotional state, physical comfort and pain. There was no significant difference in postoperative hospitalization time (P 0.05). There was no significant difference in wound healing between the two groups (P 0.05). There was no significant difference in QOR-40 score, satisfaction, tumor metastasis and recurrence between the two groups at 3 and 6 months postoperatively (P 0.05). Conclusion: continuous intraoperative infusion of 0.4 渭 g / kg of dexmetidine at a dose of 0.4 渭 g / kg / h can effectively reduce the cough response during the recovery of general anesthesia in patients undergoing thyroid surgery. Dexmetomidine (0.4 渭 g 路kg ~ (-1) 路h ~ (-1) can maintain hemodynamic stability, reduce the risk of postoperative bleeding and improve the quality of early recovery in patients undergoing thyroid surgery. It has no effect on the long-term postoperative recovery.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

【參考文獻】

相關期刊論文 前10條

1 邱小平;李正江;劉杰;安常明;殷玉林;唐平章;徐震綱;;甲狀腺術后出血的危險因素分析[J];中華耳鼻咽喉頭頸外科雜志;2016年01期

2 陳冰凝;章放香;張競超;方華;趙倩;劉承銘;梁文通;;針刺對婦科腹腔鏡術后患者早期恢復質量的影響:QoR-40量表[J];中華麻醉學雜志;2015年12期

3 聶芳;李昱潔;曹建國;皋源;杭燕南;;右美托咪定對術后譫妄的預防和治療作用[J];國際麻醉學與復蘇雜志;2015年05期

4 李文江;王燦燦;李安寶;蔣金華;余健;;氣管拔管前應用右美托咪定對甲狀腺手術患者麻醉復蘇的影響[J];蚌埠醫(yī)學院學報;2014年12期

5 葉軍霞;顧勇偉;;小劑量右美托咪定復合丙泊酚在無痛人流中的應用[J];浙江創(chuàng)傷外科;2014年02期

6 李曉松;劉海濤;任建軍;董振明;;右美托咪定對心肺轉流心內直視手術患兒血流動力學及應激反應的影響[J];臨床麻醉學雜志;2012年10期

7 梁樺;劉洪珍;王漢兵;文先杰;周橋靈;徐楓;楊承祥;;右美托咪定對結腸癌根治術病人圍術期細胞免疫功能和血循環(huán)微轉移的影響[J];中華麻醉學雜志;2012年10期

8 邵新峰;邢玉英;;右美托咪定在臨床麻醉中應用的研究現(xiàn)狀[J];中華臨床醫(yī)師雜志(電子版);2012年18期

9 李穎;劉亞慶;裴凌;;右美托咪定與咪達唑侖在局部麻醉下眼部美容術中鎮(zhèn)靜效果的比較[J];中國美容整形外科雜志;2012年09期

10 黃毅;吳秀國;;右旋美托咪定復合異丙酚在無痛人流中的應用[J];海峽藥學;2012年05期

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