本文選題：全身麻醉 + 硬膜外聯(lián)合全身麻醉　； 參考：《蚌埠醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:探討單純?nèi)砺樽?general anesthesia)、硬膜外聯(lián)合全身麻醉(epidural anesthesia combined general anesthesia)、腹橫肌平面阻滯聯(lián)合全身麻醉(transversus abdominis plane block combined general anesthesia )三種不同的麻醉方法在腦電雙頻指數(shù)(bispectral index,BIS)監(jiān)測(cè)下在腎移植患者中的應(yīng)用,比較患者術(shù)中血流動(dòng)力學(xué)變化、術(shù)后蘇醒情況、早期腎功能恢復(fù)的影響及BIS應(yīng)用于腎移植的優(yōu)勢(shì),探討腎移植手術(shù)最佳的麻醉方法。方法:擬行同種異體腎移植手術(shù)患者60例,ASAⅡ～Ⅲ級(jí),年齡18～50歲,平均(35. 6±7. 4 )歲,體重45～70kg根據(jù)隨機(jī)數(shù)字法分為3組,每組20例,Ⅰ組:BIS監(jiān)測(cè)下單純?nèi)砺樽斫M;Ⅱ組:BIS監(jiān)測(cè)下硬膜外聯(lián)合全身麻醉組;Ⅲ 組:BIS 監(jiān)測(cè)下腹橫肌平面阻滯(transversus abdominis plane block,TAP)聯(lián)合全身麻醉組。Ⅰ組病人在BIS的監(jiān)測(cè)下行靶控輸注(target controlled infusion,TCI)丙泊酚麻醉誘導(dǎo),Ⅱ組于L1-L2間隙行連續(xù)硬膜外穿刺置管給予2%利多卡因5ml,待麻醉起效后在BIS監(jiān)測(cè)下靶控輸注丙泊酚麻醉誘導(dǎo),術(shù)中間斷給予0. 375%羅哌卡因5ml; Ⅲ組于超聲引導(dǎo)下0. 5%羅哌卡因行單側(cè)腹橫肌平面阻滯,劑量為1. 5mg/kg羅哌卡因+5mg地塞米松,在BIS監(jiān)測(cè)下靶控輸注丙泊酚麻醉誘導(dǎo)。記錄術(shù)中患者入手術(shù)室時(shí)(T0)、麻醉誘導(dǎo)前(T1)、氣管插管前(T2)、氣管插管即刻(T3)、氣管插管后3min (T4),腎血管開(kāi)放前(T5)、腎血管開(kāi)放后5min(T6)各個(gè)時(shí)間點(diǎn)的MAP、CVP、HR,手術(shù)時(shí)間、麻醉時(shí)間、用藥總量、蘇醒拔管時(shí)間、蘇醒時(shí)病人疼痛情況。并于腎移植術(shù)前及術(shù)后第一天(T1)、第二天(T2)、第三天(T3)、第七天(T4),采集靜脈血,檢測(cè)血肌酐(Cr)、尿素氮(BUN)的濃度,同時(shí)記錄每日尿量。結(jié)果:1.患者一般情況、手術(shù)時(shí)間、麻醉時(shí)間三組組件比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0. 05);2.三組患者入室時(shí)(T0)血流動(dòng)力學(xué)比較無(wú)統(tǒng)計(jì)學(xué)差異(P0. 05), Ⅱ組在麻醉誘導(dǎo)前(T1)時(shí)刻MAP較T0時(shí)刻降低,差異有統(tǒng)計(jì)學(xué)意義(P0. 05),組間比較無(wú)血流動(dòng)力學(xué)無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。三組在麻醉插管期間T2、T3、T4血流動(dòng)力學(xué)比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。三組腎血管開(kāi)放后5minT6時(shí)刻MAP、CVP比開(kāi)放前T5下降,HR加快,差異有統(tǒng)計(jì)學(xué)意義(P0. 05),三組組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義。蘇醒時(shí)間Ⅱ組與Ⅲ組比Ⅰ組時(shí)間短,麻醉藥用量少、蘇醒時(shí)間短,術(shù)后疼痛例數(shù)少,差異均有統(tǒng)計(jì)學(xué)意義(P0. 05);3.血清Cr、尿素氮BUN與移植前相比,移植后一周數(shù)值均降低(P0. 05),三組患者組件比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0. 05);4.三組腎移植患者術(shù)后一周每日尿量組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0. 05),尿量術(shù)后一周與術(shù)前統(tǒng)計(jì)學(xué)比較差異(P0.05)。結(jié)論:三種麻醉方式都可以安全的應(yīng)用于腎移植手術(shù),但BIS監(jiān)測(cè)下硬膜外聯(lián)合全身麻醉,BIS監(jiān)測(cè)下腹橫肌平面阻滯聯(lián)合全麻可以減少麻醉用藥,減輕藥物蓄積,蘇醒迅速減輕疼痛,提高了患者蘇醒質(zhì)量及滿意度,對(duì)于腎移植術(shù)后腎功能恢復(fù)無(wú)不利影響,可以安全應(yīng)用于腎移植手術(shù)。
[Abstract]:Objective: to explore three different anesthesia methods: general anesthesia, epidural anesthesia combined general anesthesia combined with epidural anesthesia, abdominal transverse muscle block combined with general anesthesia transversus abdominis plane block combined general anesthesia) under the monitoring of bispectral index (bispectral index). In kidney transplant patients, The hemodynamic changes during operation, postoperative recovery, the effect of early renal function recovery and the advantages of BIS in renal transplantation were compared, and the best anesthetic method for renal transplantation was discussed. Methods: sixty patients with ASA 鈪，

本文編號(hào)：2031771