本文選題：頸叢阻滯 + 右美托咪定　； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的以芬氟合劑為對(duì)照,探討右美托咪定對(duì)頸叢阻滯下甲狀腺手術(shù)患者鎮(zhèn)靜的有效性和安全性。方法擇期頸叢阻滯下甲狀腺手術(shù)患者60例,ASA1或Ⅱ級(jí),隨機(jī)均分為：右美托咪定組(D組,30例)和對(duì)照組(C組,30例),D組緩慢輸入0.5ug/kg右美托咪定(10min內(nèi)),C組緩慢靜脈芬氟合劑1/2量,頸叢阻滯采用一點(diǎn)雙側(cè)法,藥物0.375%的羅哌卡因40ml。記錄入室時(shí)(T0)、阻滯后5min(T1)、10min已經(jīng)切皮(T2)、30min (T3).60min (T4)MBP、HR、RR、SPO2,每時(shí)段抽取3ml外周肘靜脈血,注入干燥的試管內(nèi)3O00r/min離心15min抽取血清置于-70度低溫箱保存,收齊標(biāo)本后用放射免疫法測(cè)定血漿皮質(zhì)醇(Cor)濃度以及去甲腎上腺素(E)和腎上腺素(NE)濃度(試劑盒由深圳巨豐科技公司提供),記錄術(shù)中Ramsay評(píng)分；記錄手術(shù)過(guò)程中嗆咳和肢體躁動(dòng)評(píng)分；記錄不良反應(yīng)發(fā)生情況。術(shù)后24h隨訪患者用藥后至手術(shù)結(jié)束前對(duì)有關(guān)操作的遺忘程度。結(jié)果與C組比較,T1-T4時(shí)D組Ramsay評(píng)分明顯較低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)與D組比較,T1-T4時(shí)C組的BP、HR明顯升高(P0.05)；與T0比較,T1-T4時(shí)D組的BP、HR差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),而C組的BP、HR差異有統(tǒng)計(jì)學(xué)意義(P0.05)；與T0時(shí)比較,血漿皮質(zhì)醇(Cor)濃度以及去甲腎上腺素(E)和腎上腺素(NE)濃度變化有統(tǒng)計(jì)學(xué)意義(P0.05),T2-T4時(shí)D組與C組比較也有統(tǒng)計(jì)學(xué)意義；SPO2兩組比較兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后24h隨訪,D組順行性遺忘程度高于C組(P0.05);D組嗆咳評(píng)分1分為9例(30%)、躁動(dòng)評(píng)分0-1分為27例(90%),分別多于C組的18例(60%)和19(63.4%).兩組患者未出現(xiàn)惡心、嘔吐、低血壓、局麻藥中毒等不良反應(yīng)。結(jié)論右美托咪定0.5ug/kg麻醉前10min緩慢靜脈輸注,增強(qiáng)頸叢阻滯甲狀腺手術(shù)患者的鎮(zhèn)靜效果,循環(huán)穩(wěn)定,無(wú)呼吸抑制,但偶發(fā)心動(dòng)過(guò)緩。
[Abstract]:Objective to investigate the efficacy and safety of dexmetomidine in the treatment of thyroid surgery under cervical plexus block. Methods Sixty patients undergoing selective cervical plexus block thyroidectomy were randomly divided into two groups: dexmetomidine group (n = 30) and control group (n = 30). 30 patients in control group C were treated with 0.5ug/kg dexmetomidine within 10 minutes. Cervical plexus block was performed with a bilateral method with 0.375% ropivacaine 40 ml. After 5 minutes of block, the skin was cut to T2P for 30 minutes, and T4MBPHRH / RRN SPO2 was used to extract the blood of peripheral elbow vein of 3ml at each time, and then injected into dry test tube with 3 O00r-min centrifuge 15min to store the serum in -70 degree hypothermia box, and the results showed that the blood samples were stored in a -70 degree hypothermia box, and the blood samples were stored in a -70 degree hypothermia box at each time, and the blood samples were collected from the peripheral elbow vein of 3ml. After receiving the samples, the plasma cortisol cortisone concentration, norepinephrine (E) and epinephrine (NE) concentration were measured by radioimmunoassay (the kit was provided by Shenzhen Jufeng Technology Company), and Ramsay score was recorded during the operation. To record the score of cough and limb restlessness during operation, and to record the occurrence of adverse reactions. The degree of forgetfulness of the operation after 24 h follow-up to the end of the operation. Results the Ramsay score of group D was significantly lower than that of group C at T1-T4 (P 0.05). The BPHR of group C at T1-T4 was significantly higher than that of group D at T1-T4. There was no significant difference in BPU HR between group D and T0, but there was significant difference between group C and group C (P 0.05), and there was no significant difference between group D and T0. There were significant differences in plasma cortisol (Corn), norepinephrine (E) and epinephrine (NE) concentrations between group D and group C when compared with group C (P 0.05). There was no significant difference between group D and group C (P 0.05). The degree of antegrade amnesia in group D was higher than that in group C (P 0.05). The score of dysphagia in group D was divided into 9 cases (30 cases), restlessness score (0-1) was divided into 27 cases (90 cases), which was more than that in group C (18 cases) and 1963.4% (P < 0.05). There were no adverse reactions such as nausea, vomiting, hypotension and local anaesthetic poisoning in the two groups. Conclusion the slow intravenous infusion of 10min before dexmetomidine 0.5ug/kg anesthesia can enhance the sedation effect of cervical plexus block thyroid surgery patients with stable circulation and no respiratory inhibition but occasional bradycardia.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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