發(fā)布時(shí)間：2018-06-24 16:16

  本文選題：全麻 + 老年病人��； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：研究術(shù)中保溫干預(yù)在老年患者開腹手術(shù)中對(duì)蘇醒期丙泊酚效應(yīng)室濃度，拔管時(shí)間，以及在麻醉恢復(fù)室停留（PACU）時(shí)間的影響。方法：選擇60歲以上全麻下行開腹胃腸外科手術(shù)的患者44例，ASA I~II級(jí)，隨機(jī)分為實(shí)驗(yàn)組（C組）和對(duì)照組（N組），每組22例。兩組均采用全憑靜脈麻醉下手術(shù)，麻醉后使用丙泊酚2~4ug/ml和瑞芬4ng/ml持續(xù)輸注術(shù)中鎮(zhèn)靜和鎮(zhèn)痛，并間斷推注順式阿曲庫銨維持肌松。術(shù)中監(jiān)測心電圖，血壓，氧飽和度，采用腦電雙頻指數(shù)（BIS）監(jiān)測麻醉深度，肌松監(jiān)測儀監(jiān)測患者肌松4個(gè)成串刺激(train of four, TOF)，以腔內(nèi)體溫探頭監(jiān)測食道溫度。術(shù)中實(shí)驗(yàn)組均輸入40℃的液體，暖風(fēng)毯（39℃）覆蓋，腹腔沖洗液加溫（40℃）。對(duì)照組常規(guī)處理。記錄并比較兩組患者術(shù)前（T0）麻醉誘導(dǎo)后30分鐘(T1)，60分鐘(T2)，90分鐘（T3），120分鐘（T4），150分鐘（T5）術(shù)畢（T6）的體溫，血壓，心率，氧飽和度；記錄術(shù)畢（T6），BIS恢復(fù)到80時(shí)的TOF值；記錄BIS恢復(fù)到80時(shí)候TCI系統(tǒng)計(jì)算的丙泊酚效應(yīng)室濃度（Pce），采集患者停藥到BIS≥80的時(shí)間(S0)，患者停藥到拔管時(shí)間(S1)，PACU停留時(shí)間(S2)和寒戰(zhàn)不適的例數(shù)，分析術(shù)畢（T6）溫度與丙泊酚效應(yīng)室濃度（Pce），停藥后BIS≥80時(shí)間(S0)，患者停藥到拔管時(shí)間(S1)，，PACU停留時(shí)間(S2)的相關(guān)性。結(jié)果：兩組患者術(shù)中的血壓，心率，氧飽和度比較無統(tǒng)計(jì)學(xué)差異。兩組患者在記錄術(shù)畢（T6），BIS恢復(fù)到80時(shí)的TOF值比較無統(tǒng)計(jì)學(xué)差異。對(duì)照組在T2，T3，T4，T5，T6時(shí)間點(diǎn)的溫度顯著低于實(shí)驗(yàn)組（P＜0.05）。在患者BIS恢復(fù)80時(shí)候，實(shí)驗(yàn)組的丙泊酚效應(yīng)室濃度（Pce）明顯高于對(duì)照組（P＜0.05）。與對(duì)照組相比，實(shí)驗(yàn)組自停藥到BIS回復(fù)80的時(shí)間(S0)，患者拔管時(shí)間(S1)與PACU停留時(shí)間(S2)較對(duì)照組縮短（P0.05）。在PACU，實(shí)驗(yàn)組出現(xiàn)寒顫者2例，3例患者自訴感覺寒冷。對(duì)照組出現(xiàn)寒顫者8例，10例患者自訴感覺寒冷。術(shù)中失血實(shí)驗(yàn)組低于對(duì)照組，有統(tǒng)計(jì)學(xué)意義（P＜0.05）。術(shù)畢體溫與蘇醒期丙泊酚效應(yīng)室濃度，BIS恢復(fù)時(shí)間，拔管時(shí)間，PACU停留時(shí)間相關(guān)性顯著。結(jié)論：保溫干預(yù)能較好的維持老年患者術(shù)中體溫，防止低體溫的發(fā)生，體溫對(duì)全麻老年患者的蘇醒有影響。術(shù)中維持正常的體溫能加快患者的蘇醒，縮短拔管時(shí)間以及在PACU停留的時(shí)間，減少患者在PACU寒顫不適的發(fā)生率。
[Abstract]:Objective: to study the effects of intraoperative heat preservation intervention on the concentration of propofol effector chamber, extubation time, and stay in anaesthesia recovery chamber (PACU) during open operation in elderly patients. Methods: Forty-four patients over 60 years old undergoing open gastrointestinal surgery were randomly divided into experimental group (group C) and control group (group N) with 22 cases in each group. Both groups were treated with total intravenous anesthesia. After anesthesia, propofol 2~4ug/ml and remifen 4ng/ml were used for sedation and analgesia, and cis atracurium was used to maintain muscle relaxation. Electrocardiogram (ECG), blood pressure (BP), oxygen saturation (O _ 2) were monitored during operation, anesthesia depth was monitored by bispectral index (BIS), four strands of muscle relaxation stimulation (train of four, TOF) were monitored by muscle release monitor, and esophageal temperature was monitored by endothermic probe. The experimental group was treated with 40 鈩

本文編號(hào)：2062124