本文選題：麻醉質(zhì)量 + 全麻復(fù)合硬膜外麻醉　； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：麻醉質(zhì)量是保證術(shù)中患者安全的關(guān)鍵因素，麻醉質(zhì)量包括手術(shù)麻醉時(shí)患者生命體征平穩(wěn)、內(nèi)環(huán)境穩(wěn)定、無(wú)疼痛，全麻患者還應(yīng)包括無(wú)意識(shí)并記憶消失、停麻醉后蘇醒快和平穩(wěn)、患者滿意度高，盡量節(jié)省麻醉費(fèi)用，同時(shí)還要滿足手術(shù)醫(yī)生的要求。麻醉是否成功關(guān)鍵在于麻醉質(zhì)量，隨著外科學(xué)發(fā)展，手術(shù)范圍不斷擴(kuò)大，手術(shù)種類不斷增多，患者麻醉及手術(shù)安全性越來(lái)越受到關(guān)注。有報(bào)道稱，至上世紀(jì)末麻醉相關(guān)死亡率為0.14‰，其原因有麻醉管理不當(dāng)、麻醉方法選擇不正確以及麻醉設(shè)備使用不當(dāng)?shù)�。不同資料從不同角度研究麻醉質(zhì)量對(duì)麻醉安全性的影響，然而多是從麻醉準(zhǔn)備、麻醉方法選擇或是麻醉藥物選擇等不同的側(cè)面，通過(guò)觀察進(jìn)行臨床總結(jié)，取得一定的經(jīng)驗(yàn)，尚缺乏有關(guān)麻醉方法影響麻醉質(zhì)量的系統(tǒng)性研究，麻醉質(zhì)量受多種因素影響，因此本研究從麻醉方法、麻醉用藥以及術(shù)中麻醉維持等方面探討影響麻醉質(zhì)量的原因及如何提高麻醉質(zhì)量。 目的 本研究對(duì)不同麻醉方式患者循環(huán)功能、內(nèi)環(huán)境穩(wěn)定指標(biāo)、氣管導(dǎo)管拔出時(shí)間及蘇醒時(shí)間、術(shù)后不良反應(yīng)、躁動(dòng)情況、患者術(shù)中知曉情況、術(shù)后麻醉滿意度、麻醉費(fèi)用等麻醉質(zhì)量相關(guān)指標(biāo)進(jìn)行比較分析；并探討相同組別不同觀察時(shí)間點(diǎn)循環(huán)功能變化、血中腎上腺素（EPI）及去甲腎上腺素（NA）濃度、血?dú)鈾z測(cè)結(jié)果、術(shù)后痛覺(jué)評(píng)分變化情況，綜合評(píng)價(jià)麻醉質(zhì)量，以期為臨床麻醉工作提供相應(yīng)參考。 方法 選取2013年11月至2014年3月，遼寧省人民醫(yī)院普外科全身麻醉或全身麻醉復(fù)合硬膜外麻醉下腹部胃、腸手術(shù)患者150例，隨機(jī)數(shù)字法分為G1組（吸入七氟烷＋丙泊酚＋維庫(kù)溴銨）、G2組（吸入七氟烷＋瑞芬太尼＋丙泊酚＋維庫(kù)溴銨）和GE組（吸入七氟烷＋丙泊酚＋維庫(kù)溴銨＋連續(xù)硬膜外麻醉），每組各50例。收集患者循環(huán)功能變化、內(nèi)環(huán)境穩(wěn)定指標(biāo)、患者術(shù)中輸液量、尿量、麻醉藥用量、術(shù)后不良反應(yīng)、麻醉費(fèi)用等麻醉質(zhì)量相關(guān)因素。采用Excel表格錄入數(shù)據(jù)，SPSS18.0進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差（x±ｓ）表示，采用t檢驗(yàn)或方差分析進(jìn)行比較；計(jì)數(shù)資料用率或構(gòu)成比表示。顯著性水平為P＜0.05。 結(jié)果 1.循環(huán)功能變化：G1組各時(shí)間點(diǎn)SBP值均高于GE組，G2組T5、T6、T7SBP值均高于GE組； G1組除T2點(diǎn)之外各時(shí)間點(diǎn)DBP值均高于GE組，G2組T1、T3、T4、T5時(shí)間點(diǎn)DBP值均高于GE組；G1組除T1外，其余時(shí)間點(diǎn)HR值均高于GE組，，G2組僅T1點(diǎn)HR值顯著高于GE組；G1組T1、T2BIS值顯著高于GE組，T4、T5、T6、T7點(diǎn)低于GE組，G2組T4、T5、T6、T7點(diǎn)均顯著低于GE組。 2.內(nèi)環(huán)境穩(wěn)定指標(biāo)：G1組T2時(shí)間點(diǎn)SpO2值低于GE組，T6時(shí)間點(diǎn)SpO2值高于GE組，G2組T6、T7高于GE組；G1組在三個(gè)觀察時(shí)間點(diǎn)EPI、NA濃度均顯著高于GE組；GE組T4時(shí)間點(diǎn)PaCO2濃度均高于G1組和G2組，GE組T6時(shí)間點(diǎn)血PaO2值低于G1組，GE組T4、T5、T6時(shí)間點(diǎn)血PaO2值均低于G2組；G1組在T0、T4時(shí)間點(diǎn)Hb值均高于G2組及GE組。 3. GE組氣管導(dǎo)管拔出時(shí)間及蘇醒時(shí)間與G1組和G2組比較均顯著縮短。G2組氣管導(dǎo)管拔出時(shí)Riker評(píng)分相對(duì)較高，顯著高于G1組。 4.七氟烷用量GE組顯著少于G1組和G2組；丙泊酚用量GE組顯著少于G1組；維庫(kù)溴銨用量GE組顯著少于G1組。 5.三組患者術(shù)中輸液量、麻醉費(fèi)用無(wú)差異；術(shù)中均無(wú)知曉、無(wú)躁動(dòng)；術(shù)后不良反應(yīng)較少，且均較輕。GE組患者術(shù)中尿量顯著高于G1、G2組 6. GE組患者術(shù)后12~24h痛覺(jué)評(píng)分顯著低于G1組。GE組患者麻醉滿意度相對(duì)較高。 結(jié)論 1.三種麻醉方法均能滿足患者手術(shù)要求，術(shù)中無(wú)痛覺(jué)、無(wú)知曉。 2.手術(shù)結(jié)束停麻醉后蘇醒較快、氣管拔管時(shí)無(wú)躁動(dòng)。 3.術(shù)后惡心、嘔吐及頭暈發(fā)病率低，無(wú)其他并發(fā)癥。 4.綜合評(píng)價(jià)，全麻復(fù)合硬膜外阻滯麻醉質(zhì)量最優(yōu)，是腹部手術(shù)的首選方法。
[Abstract]:Anesthesia quality is the key factor to ensure the patient ' s safety during operation . The anesthesia quality includes the patient ' s vital signs , stable internal environment and no pain after anesthesia .

Purpose

In this study , the indexes of circulatory function , internal environment stabilization index , tracheal catheter withdrawal time and wake - up time , postoperative adverse reaction , agitation , patient ' s knowledge , postoperative anesthesia satisfaction and anesthesia cost were compared .
The changes of circulating function , the concentration of epinephrine ( EPI ) and noradrenaline ( NA ) in the same group , the results of blood gas detection and the change of postoperative pain score were discussed , and the quality of anesthesia was evaluated comprehensively with a view to providing a corresponding reference for clinical anesthesia .

method

In November 2013 to March 2014 , 150 patients undergoing general anesthesia or general anesthesia combined epidural anesthesia with general anesthesia or general anesthesia were randomly divided into two groups : G1 group ( inhaled heptafluoroalkane + propofol + vecuronium bromide ) , group G2 ( inhaled heptafluoroalkane + propofol + vecuronium bromide ) and GE group ( inhaled heptafluoroalkane + propofol + vecuronium bromide + continuous epidural anesthesia ) .
The significance level was P & lt ; 0.05 .

Results

1 . The change of circulating function : SBP value in G1 group was higher than that of GE group and group G2 T5 , T6 and T7SBP were higher than GE group .
The DBP values of G1 , T3 , T4 and T5 were higher than those of GE group except for T2 .
The HR value of G1 group was higher than that of GE group except T1 , and the HR value of group G2 was significantly higher than that of GE group .
The T1 and T2BIS values in G1 group were significantly higher than those of GE group , T4 , T5 , T6 , T7 point lower than GE group , group G2 T4 , T5 , T6 and T7 were significantly lower than GE group .

2 . Internal environmental stability index : SpO2 value in G1 group was lower than that of GE group , and SpO2 value was higher than that of GE group and T6 and T7 in group G2 were higher than GE group .
The concentration of EPI and NA was significantly higher in G1 group than in GE group .
The concentration of PaCO 2 in the GE group was higher than that in G1 group and G2 group , and the time point of the GE group was lower than that in G1 group , and that of GE group T4 , T5 and T6 was lower than G2 group .
The Hb value of G1 group at T0 and T4 was higher than that of G2 group and GE group .

3 . Compared with G1 and G2 groups , the time and time of tracheal catheter withdrawal from GE group were significantly shorter than those in G1 and G2 groups . Riker score was higher in G2 group than in G1 group .

4 . The GE group was significantly less than G1 and G2 group .
The dosage of propofol was significantly lower in GE group than in G1 group .
The dose of vecuronium was significantly lower in GE group than in G1 group .

5 . There was no difference in infusion volume and anesthesia cost in three groups .
There was no awareness in the operation , no agitation ;
In GE group , the urinary volume was significantly higher in GE group than in G1 and G2 group .

6 . The pain score of patients with GE group was significantly lower than that in G1 group .

Conclusion

1 . Three kinds of anesthesia methods can meet the requirements of the patient ' s operation , no pain in operation and no knowledge .

2 . At the end of the operation , it was quicker to wake up after anesthesia , and there was no agitation in the tracheal extubulation .

3 . Postoperative nausea , vomiting and dizziness were low and there were no other complications .

4 . Comprehensive evaluation , general anesthesia combined epidural anesthesia quality optimal , is the preferred method of abdominal surgery .
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614.2

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