發(fā)布時(shí)間：2018-06-17 16:52

  本文選題：腦電雙頻指數(shù) + 淺麻醉狀態(tài)　； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本課題通過對(duì)全身麻醉手術(shù)患者術(shù)后復(fù)蘇,對(duì)不同蘇醒狀態(tài)下的病人進(jìn)行圍拔管期的觀察。通過BIS監(jiān)測、RASS評(píng)分、STEWARD評(píng)分、血氧飽和度等客觀指標(biāo)進(jìn)行安全性評(píng)價(jià);對(duì)心血管反應(yīng)、拔管時(shí)間、拔管記憶、復(fù)蘇舒適度、疼痛評(píng)分及術(shù)后并發(fā)癥發(fā)生率等方面進(jìn)行比較。研究拔管知曉和圍拔管期不愉快記憶的相關(guān)因素,為制定更為人性、個(gè)體化拔管方案提供參考依據(jù)。方法:選擇美國麻醉醫(yī)師協(xié)會(huì)(ASA)I~II級(jí),無明顯心血管疾病、肥胖和通氣功能障礙的手術(shù)病人全身麻醉氣管拔管101例。兩組患者的性別,ASA分級(jí),體重,年齡,手術(shù)時(shí)長無明顯差異。記錄患者術(shù)前向患者和家屬告知實(shí)驗(yàn)內(nèi)容,術(shù)前完善相關(guān)檢查,無明顯困難氣道與心胸疾病,無精神疾病和認(rèn)知功能障礙。隨機(jī)分為C組清醒拔管組81例,E組BIS監(jiān)測下淺麻醉拔管組20例。數(shù)據(jù)收集完畢后,根據(jù)本研究所制定的記憶評(píng)分表,按照術(shù)后第一天的記憶評(píng)分將C組內(nèi)分為C1組(術(shù)后記憶評(píng)分2分組)和C2組(術(shù)后記憶評(píng)分≥2分組)進(jìn)行進(jìn)一步討論。于麻醉前(T0)、手術(shù)結(jié)束時(shí)(T1)、脫離呼吸機(jī)時(shí)(T2)、拔管時(shí)(T3)、拔管后5min(T4)、拔管后10min(T5)及出PACU時(shí)(T6)時(shí)點(diǎn),記錄心率(HR)收縮壓(SBP)、舒張壓(DBP)、平均動(dòng)脈壓(MAP)、血氧飽和度(SPO2)、腦電雙頻指數(shù)(BIS)、鎮(zhèn)靜程度評(píng)分(RASS評(píng)分)。記錄出PACU時(shí)(T6)時(shí)點(diǎn)的動(dòng)脈血?dú)夥治鼋Y(jié)果。詳細(xì)記錄患者民族、文化程度、文化程度與職業(yè)等基本信息,記錄麻醉時(shí)長、手術(shù)時(shí)長、術(shù)中出血量、拔管后隨即對(duì)患者進(jìn)行疼痛評(píng)分和拔管記憶評(píng)分,拔管前隨機(jī)出示一張圖片讓患者觀察,并于術(shù)后一天詢問是否記得,同時(shí)再次進(jìn)行疼痛評(píng)分與拔管記憶評(píng)分,并詢問患者是否存在咽痛、咳嗽、咳痰及頭暈嘔吐等癥狀。運(yùn)用SPSS17.0統(tǒng)計(jì)軟件對(duì)收集到的數(shù)據(jù)進(jìn)行數(shù)據(jù)統(tǒng)計(jì),對(duì)計(jì)量資料進(jìn)行正態(tài)性分析,滿足正態(tài)分布資料以均數(shù)士標(biāo)準(zhǔn)差表示,重復(fù)測量資料比較采用重復(fù)測量的方差分析,組間比較采用單因素方差分析,率的比較用卡方檢驗(yàn)。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:(1)C組與E組患者心率、平均動(dòng)脈壓和血氧飽和度的變化。組間比較:T2-T4時(shí)點(diǎn)C組MAP顯著高于E組(P0.05);T3時(shí)間點(diǎn)C組HR顯著高于E組,(P0.05);HR、MAP在其余時(shí)點(diǎn)比較差異無統(tǒng)計(jì)學(xué)意義,SPO2各時(shí)點(diǎn)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組內(nèi)比較:兩組各時(shí)點(diǎn)SPO2差異無統(tǒng)計(jì)學(xué)意義(P0.05)。C組MAP在T3時(shí)點(diǎn)顯著高于其他時(shí)間點(diǎn),與T0比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),T1、T2和T4-T6與T0比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05),E組各時(shí)間點(diǎn)MAP與T0比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。C組HR除T3時(shí)點(diǎn)與T0比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)外,其余時(shí)點(diǎn)與T0比較差異均無統(tǒng)計(jì)學(xué)意義。E組各時(shí)點(diǎn)與T0比較均無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)C組與E組RASS評(píng)分的比較。組間比較:C組在T3、T4和T5時(shí)點(diǎn)RASS評(píng)分顯著大于E組,組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余時(shí)間點(diǎn)C組和E組RASS評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組內(nèi)比較:兩組患者其余時(shí)點(diǎn)的RASS評(píng)分均顯著大于T1,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)C組與E組T6時(shí)點(diǎn)動(dòng)脈血氧分壓、動(dòng)脈血二氧化碳分壓及氧合指數(shù)的比較。組間比較:T6時(shí)點(diǎn)C組與E組動(dòng)脈血氧分壓、動(dòng)脈血二氧化碳分壓、氧合指數(shù)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(4)C組與E組拔管時(shí)間、記憶評(píng)分、疼痛評(píng)分、是否術(shù)后鎮(zhèn)痛、和術(shù)后并發(fā)癥的比較。組間比較:E組拔管后記憶和術(shù)后一天記憶評(píng)分均顯著低于C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);E組拔管時(shí)長短于C組,組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組間疼痛評(píng)分(手術(shù)當(dāng)天疼痛評(píng)分和術(shù)后一天疼痛評(píng)分)、是否術(shù)后鎮(zhèn)痛比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。E組咳嗽、咽痛、咳痰發(fā)生率顯著低于C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余術(shù)后并發(fā)癥組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(5)C1和C2組間基本資料比較。兩組一般資料比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),C2的年齡小于C1組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組間麻醉時(shí)長、手術(shù)時(shí)長和出血量組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),C2組體表手術(shù)較C1組多,組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(6)C1和C2組間記憶和疼痛評(píng)分的比較。組間比較:兩組間疼痛評(píng)分比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05),C2組分組拔管時(shí)間長于C1組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。C2組術(shù)后鎮(zhèn)痛顯著少于C1組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(7)C1組和C2組HR、MAP和SPO2的變化。組間比較:HR和MAP在各個(gè)時(shí)間點(diǎn)組間比較差異均無統(tǒng)計(jì)學(xué)差異(P0.05)。組內(nèi)比較:C1組和C2組MAP在各個(gè)時(shí)點(diǎn)與T0比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05),兩組HR在T3時(shí)點(diǎn)均較T0時(shí)刻增大,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余時(shí)點(diǎn)HR與T0時(shí)點(diǎn)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(8)C1組和C2組RASS評(píng)分比較。組內(nèi)比較:兩組的RASS評(píng)分在T2-T6時(shí)間點(diǎn)均較T1時(shí)點(diǎn)顯著更高,均在T6時(shí)刻接近0,各時(shí)點(diǎn)與T1比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。組間比較:兩組在T5時(shí)點(diǎn)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余時(shí)點(diǎn)組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(9)C1與C2組間拔管時(shí)間、記憶評(píng)分和疼痛評(píng)分、術(shù)后鎮(zhèn)痛的比較。兩組間疼痛評(píng)分比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),C2組拔管時(shí)間顯著長于C1組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。C2組術(shù)后鎮(zhèn)痛例數(shù)顯著低于于C1組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(10)除咳痰外,兩組術(shù)后并發(fā)癥組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),C1組的術(shù)后并發(fā)癥中咳痰發(fā)生率低于C2組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1、BIS值65-75拔除氣管導(dǎo)管,可消除全麻復(fù)蘇患者拔管的不良記憶,是一種安全舒適的全麻復(fù)蘇技術(shù)。2、術(shù)后鎮(zhèn)痛有助于消除拔管不良記憶。
[Abstract]:Objective: To observe the peri - extubation period of patients with different revival state through the resuscitation after general anesthesia, through BIS monitoring, RASS score, STEWARD score, blood oxygen saturation and other objective indexes, and the cardiovascular response, extubation time, extubation memory, resuscitation comfort, pain score and postoperative The relative factors of the incidence of complications were compared. The related factors of unpleasant memory in extubation awareness and peri extubation period were studied to provide a reference for making a more human and individualized extubation scheme. Methods: select the American anesthesiologist Association (ASA) I~II, with no significant cardiovascular disease, obesity and ventilatory dysfunction. There were 101 cases of tube extubation. There were no significant differences in sex, ASA classification, weight, age, and length of operation in the two groups. The patients and their families were informed of the experimental contents before operation. Before the operation, the patients were informed of the experimental contents, the airway and cardiothoracic diseases, no mental illness and cognitive impairment were not obvious before the operation. 81 cases were divided into group C sober extubation group, and E group was monitored under BIS monitoring. 20 cases in the shallow anaesthetized extubation group. After the data collection, according to the memory score made in this study, the C group was divided into group C1 (2 groups after operation memory score) and group C2 (postoperative memory score > 2). Before anesthesia (T0), at the end of the operation (T1), out of the ventilator (T2), extubation Time (T3), 5min (T4) after extubation, 10min (T5) and PACU (T6) point after extubation, record heart rate (HR) systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), oxygen saturation (SPO2), EEG double frequency index, and degree of sedation. Degree, degree of education and occupation, record the length of anaesthesia, the length of the operation, the amount of bleeding in the operation, the pain score and the extubation memory score of the patients immediately after extubation, a picture before the extubation was given to the patients to be observed, and one day after the operation, whether the patient was remembered, and the pain score and the extubation memory score were also carried out again. Ask the patient whether there are symptoms of sore throat, cough, expectoration, dizziness, vomiting and other symptoms. SPSS17.0 statistics software is used to carry out data statistics on collected data, carry on normal analysis to the measurement data, meet normal distribution data with the standard deviation of the number of men, repeated measurement data compared with the repeated measurement of variance analysis, and comparison among groups. Using single factor analysis of variance, the comparison of the ratio with chi square test.P0.05 was statistically significant. Results: (1) heart rate, mean arterial pressure and blood oxygen saturation in group C and E group. Group MAP was significantly higher than group E (P0.05) in C group at T2-T4 point, and HR in T3 time point C group was significantly higher than that in E group. There was no statistical significance (P0.05) at each time point of SPO2. There was no statistically significant difference between the two groups at each time point (P0.05) and the MAP in the.C group was significantly higher than the other time points in T3 point, and there was a significant difference between T0 and T0 (P0.05), T1, T2 and T4-T6 and T4-T6. There was no statistical difference between group 0 and T0 in group.C (P0.05). There was no significant difference between T0 and T0 in group.C (P0.05). There was no statistically significant difference between the other time points and T0 (P0.05). (P0.05). (2) the comparison between C and E groups. There was significant difference between groups (P0.05), and there was no significant difference in RASS score between group C and E at the rest of time (P0.05). In group two, the other time points were significantly higher than T1, and the difference was statistically significant (P0.05). (3) the arterial oxygen pressure, the partial pressure of carbon dioxide in the arterial blood and the oxygenation index in the C group and E group T6 time. Comparison: comparison between groups: there was no significant difference in oxygen pressure between group C and group E at T6 time and E group, the partial pressure of carbon dioxide in arterial blood, and no significant difference in oxygenation index (P0.05). (4) the time of extubation, memory score, pain score, postoperative analgesia, and postoperative complications were compared between group C and group E. The comparison between group E and postoperative memory scores in E group and postoperative memory scores were all Significantly lower than the C group, the difference was statistically significant (P0.05), in group E, when extubation was in group C, there was a significant difference between groups (P0.05). Two groups of pain scores (pain scores and one day pain score after operation), and whether postoperative analgesia was not statistically significant (P0.05) the incidence of cough, sore throat, and expectoration in group.E was significantly lower than that of C. The difference was statistically significant (P0.05), and there was no significant difference between the other postoperative complications groups (P0.05). (5) the basic data of group C1 and C2 were compared. The general data of the two groups had no statistical significance (P0.05), the age of C2 was less than the C1 group, and the difference was statistically significant (P0.05). The length of anesthesia between the two groups, the length of the operation and the volume of bleeding were between the groups. There was no statistically significant difference (P0.05), and there was a significant difference between group C2 and group C1 (P0.05). (6) the comparison of memory and pain scores between groups of C1 and C2. There was no statistical difference between groups (P0.05), and the extubation time of group C2 group was longer than that in group C1 (P0.05). Group.C2 postoperative analgesia was significantly less than group C1, the difference was statistically significant (P0.05). (7) the changes of HR, MAP and SPO2 in group C1 and C2 group. There was no statistical difference between the groups of HR and MAP in each time point group (P0.05). The difference was statistically significant (P0.05), and there was no significant difference between HR and T0 at the other time points (P0.05). (8) the RASS scores of group C1 and C2 group were compared. The RASS scores in the two groups were significantly higher in T2-T6 time points than in T1 time points, and both were close to 0 at the moment of T6, and there were significant differences in each time point. 0.05) comparison: there was a significant difference between the two groups at T5 time points (P0.05), and there was no significant difference between the other time points (P0.05). (9) the extubation time between the C1 and C2 group, the memory score and the pain score, and the postoperative analgesia were compared. There was no statistical difference between the two groups (P0.05), and the extubation time in the C2 group was significantly longer than C1. Group, the difference was statistically significant (P0.05) the number of postoperative analgesia in group.C2 was significantly lower than that in group C1 (P0.05). (10) except for expectoration, there was no significant difference in postoperative complications between the two groups (P0.05), and the incidence of expectoration in group C1 was lower than that in group C2 (P0.05). Conclusion: 1, BIS value 65-75. The removal of tracheal catheter can eliminate the bad memory of extubation in patients with general anesthesia. It is a safe and comfortable general anesthesia recovery technique.2. Postoperative analgesia helps to eliminate the bad memory of extubation.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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