本文選題：低體溫 + 低流量麻醉��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景及目的術(shù)中意外低體溫(hypothermia)是圍手術(shù)期間常見并發(fā)癥之一,可引發(fā)一系列不良后果,不利于患者術(shù)后的康復(fù)。因此,在圍手術(shù)期間防治低體溫并發(fā)癥十分必要。除減少環(huán)境污染、獲取經(jīng)濟效益外,低流量麻醉(low flow anesthesia,LFA)已證實可改善麻醉呼吸回路中吸入氣體的溫度和濕度。在臨床實踐中,吸入麻醉藥物七氟醚被廣泛運用于LFA技術(shù)。本研究采用前瞻性、隨機、對照的研究方法,觀察不同新鮮氣體流量(Fresh gas flow,FGF)對泌尿外科腹腔鏡腎臟手術(shù)患者術(shù)中體溫的影響。資料與方法選取擇期行腹腔鏡腎臟手術(shù)的患者60例,ASA分級I-II,隨機分成三組,每組各20例。H組:麻醉維持階段FGF為2 L · min-1。M組:麻醉維持階段FGF為1 L · min-1。L組:麻醉維持階段FGF為0.75L · min-1。室內(nèi)溫度維持在22℃C-23℃C,相對濕度40%-60%。每組患者術(shù)中非手術(shù)區(qū)域皮膚均覆蓋相同材質(zhì)的無菌單,術(shù)中輸入未加溫液體。采用靜脈吸入復(fù)合全麻,麻醉誘導(dǎo)給予咪達唑侖(midazolam)0.05mg · kg-1,舒芬太尼(sufentanil)0.2 ug · kg-1、依托咪酯(tomidate)0.2mg · kg-1 和羅庫溴銨(rocuronium)0.6mg · kg-1。七氟醚持續(xù)吸入、順式阿曲庫胺(cisatracurium)間斷給予維持麻醉。喉罩(LMASupreme)置入后,置入鼻咽溫度探測元件評估核心溫度,監(jiān)測前臂-指尖體表溫度差評估指尖血流灌注。于麻醉誘導(dǎo)后即刻(T1)開始,每隔15分鐘記錄一次呼氣末二氧化碳分壓(ETC02)、呼氣末七氟醚濃度(ETSC)、血氧飽和度(Sp02)、鼻咽溫度(Tc)、前臂溫度(Ta)、指尖溫度(Tf)、心率(HR)和平均動脈壓(MAP),至停七氟醚時刻(T10)。Ta減去Tf即為前臂-指尖體表溫度差(Ta-f)。研究結(jié)果1.一般資料三組患者分別在性別、年齡、身高、體重指數(shù)、手術(shù)時間、麻醉時間、術(shù)中液體輸注量、術(shù)中尿量、術(shù)中失血量等方面無統(tǒng)計學(xué)差異(p0.05)。2.心率變化手術(shù)麻醉過程中,三組患者的HR降趨勢,后緩慢升高。但三組間HR變化無顯著差異(p0.05)。與基礎(chǔ)HR相比,三組患者HR變化無明顯統(tǒng)計學(xué)差異(p0.05)。3.平均動脈壓變化三組患者的MAP變化無明顯統(tǒng)計學(xué)差異(p0.05)。與基礎(chǔ)MAP相比,三組患者MAP變化無明顯統(tǒng)計學(xué)差異(p0.05)。4.核心溫度變化靜脈麻醉誘導(dǎo)后,三組患者Tc均呈下降趨勢:先顯著下降,后下降趨勢逐漸變緩。H組Tc在T10(停七氟醚時刻)下降0.94℃,降至36℃以下;M組Tc下降0.59℃,L組Tc降低0.44℃,但兩組均在36℃以上。在T1、T2和T3時間監(jiān)測點,三組間Tc變化無顯著差異(p0.05)。H組Tc從T4時刻(誘導(dǎo)后45min)開始低于L組患者(p0.05);M組Tc從T5時刻開始低于M組患者(p0.05);M組Tc從T7時刻開始低于L組患者(p0.05)。與T1(麻醉誘導(dǎo)后即刻)相比,三組患者Tc均于T4時刻起變化有明顯統(tǒng)計學(xué)差異(p0.05)。5.前臂-指尖體表溫度差變化三組患者的Ta-f均逐漸升高。H組Ta-f于T9時刻、M組Ta-f于T8時刻、L組Ta-f于T7時刻由負值轉(zhuǎn)為正值。但三組間Ta-f變化差異無統(tǒng)計學(xué)意義(p0.05)。H組從T7時間點開始記錄的Ta-f值與T1值相比均有顯著差異(p0.05);M組和L組在T6時間點開始記錄的Ta-f值與T1值相比均有顯著差異(p0.05)。研究結(jié)論:0.75 L · min-1和1 L · min-1的FGF與2 L · min-1的FGF相比均可有效預(yù)防腹腔鏡患腎臟手術(shù)患者術(shù)中低體溫并發(fā)癥的發(fā)生。而與1 L · min-1的FGF的相比較,0.75 L · min-1的FGF麻醉對患者體溫的保護作用更顯著。
[Abstract]:Background and objective intraoperative hypothermia (hypothermia) is one of the common complications during perioperative period, which can lead to a series of adverse consequences and is not conducive to postoperative rehabilitation. Therefore, it is necessary to prevent hypothermia complications during perioperative period. In addition to reducing environmental pollution and obtaining economic benefits, low flow anaesthesia (low flow anesthesia) LFA) has proved to improve the temperature and humidity of the inhaled gas in the anesthetic respiratory circuit. In clinical practice, the inhaled anesthetic sevoflurane is widely used in LFA technology. This study uses a prospective, randomized, controlled study to observe the different fresh gas flow (Fresh gas flow, FGF) for laparoscopic renal surgery in the Department of urology. Data and methods 60 cases of laparoscopic renal surgery were selected and divided into three groups, 20 cases of.H group in each group: FGF of 2 L. Min-1.M at the maintenance stage of anesthesia: FGF of 1 L. Min-1.L at the maintenance stage of anesthesia: FGF to 0.75L in the maintenance phase of anesthesia at 22 degrees centigrade. A sterile sheet of the same material was covered with the same material in the non operative area of each group of patients with humidity 40%-60%.. Inputting the unheated liquid during the operation. Intravenous inhalation combined general anesthesia was used to induce midazolam (midazolam) 0.05mg. Kg-1, sufentanil (sufentanil) 0.2 UG kg-1, etomidate (tomidate) 0.2mg kg-1 and rocuronium (ROC). Uronium) 0.6mg. Kg-1. sevoflurane continuous inhalation, CIS atracuramide (cisatracurium) intermittently for maintenance anesthesia. After insertion of the laryngeal mask (LMASupreme), the core temperature of the nasopharynx temperature detection element is assessed and the forearm fingertip surface temperature difference is monitored to assess the fingertip blood flow. Immediately after the induction of anesthesia (T1), every 15 minutes is recorded. The end expiratory carbon dioxide partial pressure (ETC02), the end expiratory sevoflurane concentration (ETSC), the blood oxygen saturation (Sp02), the nasopharyngeal temperature (Tc), the forearm temperature (Ta), the fingertip temperature (Tf), the heart rate (HR) and the mean arterial pressure (MAP), to the time of stopping sevoflurane (T10).Ta minus Tf are the temperature difference between the forearm fingertip body surface (Ta-f). The results of the 1. general data of three groups of patients were respectively in Sex, age, height, body mass index, operation time, anesthesia time, intraoperative fluid infusion, intraoperative urine volume, and intraoperative blood loss were not statistically different (P0.05).2. heart rate change operation anesthesia process, the three groups of patients with HR trend, and then slow increase. But there was no significant difference in HR between the three groups (P0.05). Compared with basic HR, three groups of patients HR There was no significant difference in statistical difference (P0.05).3. mean arterial pressure changes in three groups of patients with no significant statistical difference (P0.05). Compared with the basic MAP, there was no significant difference between the three groups of patients (P0.05).4. core temperature changes induced by intravenous anesthesia, the three groups of patients showed a downward trend: the first significant decrease, then descending trend. The gradual decrease of.H group Tc dropped 0.94 degrees centigrade at T10 (stopped sevoflurane moment) and below 36 C, Tc decreased by 0.59, and L group Tc decreased 0.44 degrees C, but the two groups were above 36 centigrade. There was no significant difference between the three groups at T1, T2 and T3 time monitoring points in the two groups. In group M (P0.05), Tc in group M was lower than that in group L (P0.05). Compared with T1 (immediately after induction of anesthesia), there was a significant difference between the three groups of Tc at T4 time (P0.05). The difference in Ta-f changes between the three groups was not statistically significant (P0.05) the Ta-f value of the.H Group recorded from the T7 time point was significantly different from the T1 value (P0.05). The Ta-f values of M and L groups at T6 time points were significantly different from those of the T1 values. L / min-1's FGF can effectively prevent the occurrence of hypothermia complications during laparoscopic renal surgery. Compared with FGF of 1 L. Min-1, 0.75 L. Min-1's FGF anesthesia is more protective for the patient's body temperature.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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