本文選題：右美托咪定 + 甲狀腺手術(shù)�。� 參考：《重慶醫(yī)科大學(xué)》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(shù)患者全麻恢復(fù)期間嗆咳反應(yīng)及術(shù)后恢復(fù)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(shù)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(shù)開始時持續(xù)靜脈泵注右美托咪定0.4μg·kg~（-1）·h~（-1）至手術(shù)結(jié)束;后者則給予等容量的0.9%生理鹽水。所有患者術(shù)前常規(guī)禁飲禁食;0.5mg阿托品和25mg異丙嗪為術(shù)前用藥。手術(shù)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(shù)結(jié)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(shù)結(jié)束。觀察兩組患者全麻恢復(fù)期間嗆咳反應(yīng)情況;記錄所有患者術(shù)后第一個24h及第二個24h切口引流量;記錄麻醉誘導(dǎo)前(T0)、手術(shù)結(jié)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(shù)時間、麻醉時間、麻醉藥用量、自主呼吸恢復(fù)時間、氣管拔管時間、PACU停留時間及不良反應(yīng)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(shù)前、術(shù)后24h、術(shù)后48h、術(shù)后3個月、術(shù)后6個月時恢復(fù)質(zhì)量;記錄患者術(shù)后出血情況、切口愈合等級、術(shù)后住院時間、患者滿意度;術(shù)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(zhuǎn)移及復(fù)發(fā)情況。結(jié)果兩組患者一般資料各指標(biāo)(性別構(gòu)成比、年齡、BMI、ASA分級構(gòu)成比、高血壓病史、糖尿病病史、手術(shù)時間、麻醉時間、術(shù)中冰凍結(jié)果、術(shù)前QOR-40評分總分)比較差異無統(tǒng)計學(xué)意義(P0.05)。與C組相比,D組全麻恢復(fù)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(dǎo)管時,帶管吸痰時和拔管時(P0.05);D組術(shù)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(shù)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(shù)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(fù)時間、氣管拔管時間、PACU停留時間、術(shù)后住院時間比較差異無統(tǒng)計學(xué)意義(P0.05)。兩組患者切口愈合情況比較差異無統(tǒng)計學(xué)意義(P0.05)。兩組患者術(shù)后3個月、6個月時QOR-40評分、滿意度、腫瘤轉(zhuǎn)移及復(fù)發(fā)情況比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論(1)術(shù)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(shù)患者全麻恢復(fù)期間的嗆咳反應(yīng),具有良好的安全性;(2)術(shù)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(shù)患者圍術(shù)期血流動力學(xué)穩(wěn)定,降低患者術(shù)后出血的風(fēng)險,改善患者的早期恢復(fù)質(zhì)量,對患者的遠(yuǎn)期術(shù)后恢復(fù)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(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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