本文選題：喚醒麻醉 + 皮層定位�。� 參考：《復(fù)旦大學(xué)》2014年碩士論文

【摘要】：目的現(xiàn)有研究發(fā)現(xiàn),接受大腦功能區(qū)手術(shù)的患者,特別是臨近語(yǔ)言區(qū)的腫瘤病患,可能從術(shù)中磁共振和／或喚醒麻醉技術(shù)中獲益,即最大程度地切除病灶并減少神經(jīng)功能的缺失。然而,術(shù)中磁共振掃描的應(yīng)用明顯延長(zhǎng)了手術(shù)和麻醉時(shí)間,如何確保患者術(shù)中氣道通暢、平穩(wěn)喚醒和提高患者的舒適度,這些都要求我們制定個(gè)性化的麻醉方案。目前丙泊酚復(fù)合瑞芬太尼靶控輸注在開(kāi)顱手術(shù)的喚醒麻醉中應(yīng)用較為廣泛。右美托咪定作為高選擇性的α。受體激動(dòng)劑,具有劑量依賴性的鎮(zhèn)靜、抗焦慮和鎮(zhèn)痛作用,且?guī)缀鯚o(wú)呼吸抑制作用。然而,右美托咪定作為輔助用藥用于開(kāi)顱手術(shù)喚醒麻醉的相關(guān)研究鮮有報(bào)道,本研究將探討右美托咪定作為輔助用藥在術(shù)中磁共振環(huán)境下喚醒麻醉中應(yīng)用。方法將40例語(yǔ)言區(qū)或鄰近語(yǔ)言區(qū)膠質(zhì)瘤患者隨機(jī)分為2組,即：丙泊酚+瑞芬太尼組(P組,n=20)和右美托咪定+丙泊酚+瑞芬太尼(D組,n=20)。兩組患者均給予頭皮神經(jīng)阻滯、MAC (Monitered Anesthesia Care)喚醒麻醉和術(shù)中磁共振掃描。分別于麻醉前(T0)、誘導(dǎo)完成即刻(OAA/S評(píng)分達(dá)到1分,T0)、切皮即刻(T0)、喚醒后開(kāi)始皮層定位時(shí)(T3),關(guān)硬膜時(shí)(T0)記錄患者動(dòng)脈收縮壓(SBP)和心率(HR)。記錄達(dá)到目標(biāo)鎮(zhèn)靜深度以及切皮時(shí)丙泊酚靶濃度和瑞芬太尼的輸注速率；記錄開(kāi)顱結(jié)束以及手術(shù)結(jié)束時(shí)丙泊酚和瑞芬太尼的用量；比較兩組鎮(zhèn)靜前后的PaC02值；記錄停用丙泊酚至患者達(dá)到OAA/S評(píng)分4分的所需時(shí)間；評(píng)價(jià)兩組患者硬膜剪開(kāi)后的腦松弛度；記錄手術(shù)過(guò)程中發(fā)生的不良事件。結(jié)果D組達(dá)到目標(biāo)鎮(zhèn)靜深度及切皮時(shí)所需的丙泊酚效應(yīng)室濃度顯著低于P組(P0.05)。開(kāi)顱結(jié)束和手術(shù)結(jié)束時(shí),D組丙泊酚用量也顯著少于比P組(P0.05)。在喚醒后進(jìn)行皮層定位(T3)時(shí)D組患者收縮壓顯著低于P組(P0.05)。在誘導(dǎo)完成(T0)、切皮(T2)、喚醒后皮層定位(T0)時(shí),D組患者心率比顯著慢于P組(P0.05)。鎮(zhèn)靜完成后兩組PaC02均高于基礎(chǔ)值(P0.05),鎮(zhèn)靜后D組患者的PaC02顯著高于比P組(P0.05)。兩組患者均可順利喚醒并進(jìn)行大腦皮層定位,在喚醒時(shí)間上無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。D組患者術(shù)中高血壓和心動(dòng)過(guò)速的發(fā)生率低于比P組。其他術(shù)中不良事件兩組間無(wú)顯著性差異(如術(shù)中低血壓、心動(dòng)過(guò)緩、PaC0255mmHg、疼痛、惡心嘔吐、寒戰(zhàn)、癲癇發(fā)作以及腦膨脹)。結(jié)論右美托咪定作為輔助用藥,能使患者較好地耐受在術(shù)中磁共振環(huán)境下的喚醒麻醉。右美托咪定的使用,可以顯著降低鎮(zhèn)靜所需丙泊酚靶濃度,并減少丙泊酚用量,使患者在喚醒開(kāi)顱手術(shù)過(guò)程中循環(huán)更為平穩(wěn),減少了術(shù)中高血壓、心動(dòng)過(guò)速的發(fā)生率,且不影響喚醒質(zhì)量和喚醒時(shí)間。對(duì)于保留自主呼吸的患者,復(fù)合給予右美托咪定可增加高碳酸血癥的發(fā)生。
[Abstract]:Objective current studies have found that patients undergoing surgery in the functional areas of the brain, especially cancer patients near the language area, may benefit from intraoperative magnetic resonance imaging and / or arousal anesthesia. This is to remove the lesion to the maximum extent and to reduce the loss of nerve function. However, the application of intraoperative magnetic resonance scan can obviously prolong the operation and anesthesia time. How to ensure the airways unobstructed, wake up smoothly and improve the comfort of the patients during the operation, all of which require us to establish a personalized anesthetic scheme. At present, propofol combined with remifentanil is widely used in arousal anesthesia during craniotomy. Dexmetomidine is a highly selective 偽. Receptor agonists, with dose-dependent sedation, anti-anxiety and analgesic effects, and almost no respiratory inhibition. However, there are few reports on the use of dexmetomidine as an adjunct in arousal anesthesia in craniotomy. This study will explore the application of dexmetomidine as an adjunctive drug in arousal anesthesia in magnetic resonance field. Methods 40 patients with glioma in language area or adjacent language area were randomly divided into two groups: propofol remifentanil group (group P) and dexmetomidine propofol remifentanil group (group D). Both groups were anesthetized by scalp nerve block and magnetic resonance imaging (MRI). Before anaesthesia, the OAA / S score was 1 min, the skin incision was T0, and T _ 3 and T _ 0 were recorded respectively. The systolic blood pressure (SBP) and heart rate (HRV) were recorded at the beginning of cortical localization after arousal, and at the time of closing the dura (T _ 0), and the arterial systolic blood pressure (SBP) and heart rate (HRV) were recorded. The dose of propofol and remifentanil at the end of craniotomy and at the end of operation were recorded, and the values of PaC02 before and after sedation were compared between the two groups. To record the time to stop propofol from propofol to reach OAA / S score 4; to evaluate the brain relaxation after dural clipping in both groups; and to record the adverse events during the operation. Results the concentration of propofol effect chamber in group D was significantly lower than that in group P (P 0.05). The dosage of propofol in group D was significantly lower than that in group P (P 0.05) at the end of craniotomy and operation. The systolic blood pressure in group D was significantly lower than that in group P (P 0.05). The heart rate ratio of group D was significantly slower than that of group P (P 0.05). After sedation, the PaC02 of both groups was higher than that of basic value (P0.05), and that of group D after sedation was significantly higher than that of group P (P 0.05). The incidence of hypertension and tachycardia in group D was lower than that in group P (P 0.05). There was no significant difference in other adverse events between the two groups (such as intraoperative hypotension, bradycardia PaC0255mm Hg, pain, nausea and vomiting, shivering, seizures and brain expansion. Conclusion dexmetomidine as an adjuvant drug can make patients tolerate arousal anesthesia in magnetic resonance field. The use of dexmetomidine can significantly reduce the target concentration of propofol for sedation and the dosage of propofol, thus making the circulation of patients more stable during arousal craniotomy, reducing the incidence of hypertension and tachycardia during the operation. And does not affect the arousal quality and wake-up time. In patients with spontaneous respiration, combined administration of dexmetoimidine increased the risk of hypercapnia.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

【共引文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 李曉云;轉(zhuǎn)化糖電解質(zhì)注射液對(duì)擇期顱腦手術(shù)病人能量代謝的影響[D];河北醫(yī)科大學(xué);2014年

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本文編號(hào)：2049247