預(yù)注布托啡諾或地佐辛抑制依托咪酯誘發(fā)肌陣攣效果觀察
發(fā)布時(shí)間：2018-08-04 18:20
【摘要】：目的探討不同劑量布托啡諾或地佐辛預(yù)防依托咪酯注射后肌陣攣的可行性、安全性和有效性;比較兩種藥物對(duì)肌陣攣的抑制作用程度,同時(shí)為臨床應(yīng)用提供依據(jù)。方法本研究方案獲天津醫(yī)科大學(xué)第二醫(yī)院醫(yī)學(xué)倫理委員會(huì)批準(zhǔn),選擇擬全麻下?lián)衿谑中g(shù)患者300例。性別不限,年齡40~65歲,ASA分級(jí)Ⅰ或Ⅱ級(jí),體質(zhì)指數(shù)(BMI)20~25 kg/m2,隨機(jī)分為B、D兩組,每組各150例。B組依照預(yù)注布托啡諾的劑量不同,再分為B1、B2、B3、B4、B5共5個(gè)亞組(n=30);D組依照預(yù)注地佐辛劑量不同,再分為D1、D2、D3、D4、D5共5個(gè)亞組(n=30)。所有患者入室前均不使用任何術(shù)前藥物,入室后,連接監(jiān)護(hù)儀,監(jiān)測(cè)平均動(dòng)脈壓(MAP)、心率(HR)、脈搏血氧飽和度(SpO2)以及腦電雙頻譜指數(shù)(BIS),用20G靜脈留置針開(kāi)放右上肢靜脈,輸注乳酸鈉林格氏液。麻醉誘導(dǎo)前,B1~B4組分別靜滴布托啡諾12.5μg/kg、15μg/kg、17.5μg/kg和20μg/kg;D1~D4組分別靜滴地佐辛0.075 mg/kg、0.1 mg/kg、0.125 mg/kg和0.15 mg/kg。B5、D5兩組為對(duì)照組,均滴注等容積生理鹽水,規(guī)定每種藥物的給藥間均為30 s,在給予實(shí)驗(yàn)藥物后的2 min各組均靜脈注射依托咪酯0.3 mg/kg,并且注射時(shí)間均為1min,推注完畢后,立刻開(kāi)始觀察并記錄B、D兩組中肌陣攣發(fā)生的例數(shù)及強(qiáng)度,各組的觀察時(shí)間均為2 min,在推注依托咪酯注射液的同時(shí)詢問(wèn)患者是否存在注射痛。同時(shí)記錄全身麻醉誘導(dǎo)前(T_0)時(shí)刻、給予實(shí)驗(yàn)藥物后2 min(T_1)時(shí)刻以及靜脈注射依托咪酯后2 min(T_2)時(shí)刻,各時(shí)點(diǎn)每組患者的MAP、HR、SpO2和BIS值。并于全身麻醉誘導(dǎo)前(T_0)時(shí)刻以及氣管插管后5 min(T_3)時(shí)刻,測(cè)定各組患者靜脈血鉀的濃度。同時(shí)觀察與記錄患者頭暈、惡心、嘔吐等不良反應(yīng)的發(fā)生情況。結(jié)果在B組中,各亞組患者肌陣攣的發(fā)生率分別為33%、10%、10%、10%、70%。與B5組相比,B1、B2、B3、B4四組肌陣攣的發(fā)生率和強(qiáng)度均明顯降低,差別有統(tǒng)計(jì)學(xué)意義(P0.05),B2、B3、B4三組與B1組相比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),B2、B3、B4三組相比,無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。B2與B3、B4兩組相比,不良反應(yīng)發(fā)生的最少。B1、B2、B3、B4、B5五個(gè)亞組,患者注射痛的發(fā)生率分別為17%、10%、10%、7%、20%,各亞組患者注射痛的發(fā)生率和強(qiáng)度差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。T_0、T_1與T_2時(shí)刻五個(gè)亞組患者的MAP、HR、SpO2差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),T_1時(shí)刻B4組與其他四組相比,BIS值有所降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),T_0、T_2時(shí)刻五個(gè)亞組患者的BIS值差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。D組中,各亞組患者肌陣攣的發(fā)生率分別為43%、20%、20%、20%、70%。與D5組相比,D1、D2、D3、D4四組肌陣攣的發(fā)生率和強(qiáng)度均明顯降低,差別有統(tǒng)計(jì)學(xué)意義(P0.05),D2、D3、D4三組與D1組相比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),D2、D3、D4三組相比較無(wú)明顯差異(P0.05)。D2與D3、D4兩組相比,不良反應(yīng)發(fā)生的最少。D1、D2、D3、D4、D5五個(gè)亞組患者注射痛的發(fā)生率分別為13%、13%、10%、7%、20%,各組患者注射痛的發(fā)生率和強(qiáng)度差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。T_0、T_1與T_2時(shí)刻5組患者的MAP、HR、SpO2、BIS值差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。B2與D2組相比,肌陣攣發(fā)生率及強(qiáng)度差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者注射痛的發(fā)生率和強(qiáng)度差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。T_0、T_1與T_2時(shí)刻2組患者的MAP、HR、SpO2、BIS值差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。T_3與T_0時(shí)比較,無(wú)肌陣攣(肌陣攣強(qiáng)度0級(jí))及發(fā)生1級(jí)與2級(jí)肌陣攣的患者靜脈血鉀的濃度均沒(méi)有明顯變化(P0.05);有嚴(yán)重肌陣攣發(fā)生的患者(肌陣攣強(qiáng)度3級(jí))靜脈血鉀的濃度明顯升高(P0.05)。結(jié)論嚴(yán)重肌陣攣的患者血鉀濃度會(huì)有所升高,而且有部分患者發(fā)生肌肉酸痛。預(yù)先靜脈注射布托啡諾15.0μg/kg與12.5μg/kg、17.5μg/kg、20μg/kg布托啡諾相比更能安全、有效地抑制靜脈注射依托咪酯引起的肌陣攣;預(yù)先靜脈注射地佐辛0.100 mg/kg與0.075 mg/kg、0.125 mg/kg、0.150 mg/kg地佐辛相比更能安全、有效地抑制肌陣攣的發(fā)生。預(yù)先靜脈注射布托啡諾15.0μg/kg與地佐辛0.100mg/kg相比對(duì)肌陣攣的抑制效果無(wú)明顯差異,同時(shí)這兩種劑量的兩種藥物引起的不良反應(yīng)較少,并且二者對(duì)循環(huán)和呼吸系統(tǒng)的影響亦無(wú)差異。
[Abstract]:Objective to explore the feasibility, safety and effectiveness of the myoclonus after etomidate injection of different doses of Bhutto enphonic or dezocine, to compare the degree of inhibition of the two drugs on myoclonus, and to provide a basis for clinical application. Methods the study was approved by the medical ethics committee of Second Hospital Affiliated to Tianjin Medical University. 300 patients undergoing elective surgery under anesthesia, gender, age 40~65, ASA grade I or class II, body mass index (BMI) 20~25 kg/m2, were randomly divided into B, D two, and 150.B groups in each group were divided into B1, B2, B3, B4, and 5 subgroups according to the dosage of pre injected Bhutto phine. 5 subgroups (n=30). All patients did not use any preoperatively before entering the room. After entering the room, connecting monitor, monitoring the mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and electroencephalogram double spectrum index (BIS), using 20G venous indwelling needle to open the right upper limb vein and infusion of sodium lactate Ringer's solution. Before induction, the B1~B4 group was static, respectively. Drop Bhutto enphine 12.5 mu g/kg, 15 mu g/kg, 17.5 mu g/kg and 20 mu g/kg, D1~D4 group static drops of zocin 0.075 mg/kg, 0.1 mg/kg, 0.125 mg/kg and 0.15 mg/kg.B5, and D5 two group as control group, both drip and other volume physiological saline, which stipulate that the drug delivery between each drug is 30 s. After giving the experimental drugs, each group of 2 min is intravenously injected etomidate 0.3 G/kg, and the time of injection was 1min. After the injection, we immediately began to observe and record the number and intensity of myoclonus in the B, D two groups. The observation time of each group was 2 min. At the same time, the patients were asked if there was an injection pain at the same time, and the time before the induction of general anesthesia (T_0) was recorded and 2 MI after the experimental drug was given. At the time of n (T_1) and 2 min (T_2) time after intravenous etomidate, the values of MAP, HR, SpO2 and BIS at each time point were measured at each time point. The concentrations of potassium in venous blood were measured in each group of patients before and before the induction of general anesthesia (T_0) and at the 5 min (T_3) at the endotracheal intubation. The occurrence of adverse reactions such as dizziness, nausea and vomiting were observed and recorded. Results in group B, the incidence of myoclonus was 33%, 10%, 10%, 10%. Compared with group B5, the incidence and intensity of myoclonus in group B1, B2, B3, B4 four were significantly lower, and the difference was statistically significant (P0.05), B2, B3, B4 three, compared with the B1 group, there was no statistically significant difference. Difference (P0.05).B2 was the least.B1, B2, B3, B4, B5 five subgroups of B3 and B4 two groups, and the incidence of injection pain in patients was 17%, 10%, 10%, 7%, 20%. There was no statistically significant difference in the incidence and intensity of injection pain in the subgroups of the subgroups (P0.05).T_0, and there was no statistical difference between the T_1 and the five subgroups (P0.05), at the time of T_1, the BIS value of group B4 was lower than that of the other four groups, and the difference was statistically significant (P0.05), T_0, and T_2 time of the five subgroups had no statistical significance (P0.05).D group, and the incidence of myoclonus in each subgroup was 43%, 20%, 20%, 20%, and 70%. compared with the D5 group, and the incidence and strength of the four groups of myoclonus The difference was statistically significant (P0.05), D2, D3, D4 three and D1 group were statistically significant (P0.05), D2, D3, D4 three groups had no significant difference (P0.05).D2 and D3, five subgroups of adverse reactions were 13%, 13%, 10%, 7%, 20%, respectively. There was no significant difference in the incidence and intensity of injection pain in patients (P0.05).T_0, T_1 and T_2 at the time of MAP, HR, SpO2, BIS value difference was not statistically significant (P0.05).B2 and D2 group, there was no significant difference in the incidence and intensity of myoclonus (P0.05); the incidence and intensity of injection pain in the two groups had no statistical significance. .T_0, T_1, and T_2 time 2 groups of patients with MAP, HR, SpO2, BIS values were not statistically significant (P0.05).T_3 and T_0 compared, no myoclonus (myoclonus intensity 0) and 1 and 2 stage myoclonus of patients with venous blood potassium concentration did not change significantly (P0.05); there are severe myoclonus (3 levels of myoclonus strength 3) concentration of venous blood potassium concentration Significant increase (P0.05). Conclusion the concentration of blood potassium in patients with severe myoclonus will increase, and some patients have muscle soreness. The pre intravenous injection of Bhutto enphine 15 mu g/kg and 12.5 mu g/kg, 17.5 u g/kg, 20 mu g/kg Bhutto enphine can be more safe and effective to inhibit myoclonus caused by intravenous etomidate; pre intravenous injection. Dezocin 0.100 mg/kg is safer and more effective than 0.075 mg/kg, 0.125 mg/kg, 0.150 mg/kg, and effectively inhibits the occurrence of myoclonus. There is no significant difference in the inhibition of myoclonus by pre intravenous injection of Bhutto eno 15 UX 0.100mg/kg to dezocin 0.100mg/kg, and fewer adverse reactions caused by two kinds of drugs of these two doses, and There was no difference in the effects of the two on circulation and respiratory system.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R614.2
本文編號(hào)：2164713
[Abstract]:Objective to explore the feasibility, safety and effectiveness of the myoclonus after etomidate injection of different doses of Bhutto enphonic or dezocine, to compare the degree of inhibition of the two drugs on myoclonus, and to provide a basis for clinical application. Methods the study was approved by the medical ethics committee of Second Hospital Affiliated to Tianjin Medical University. 300 patients undergoing elective surgery under anesthesia, gender, age 40~65, ASA grade I or class II, body mass index (BMI) 20~25 kg/m2, were randomly divided into B, D two, and 150.B groups in each group were divided into B1, B2, B3, B4, and 5 subgroups according to the dosage of pre injected Bhutto phine. 5 subgroups (n=30). All patients did not use any preoperatively before entering the room. After entering the room, connecting monitor, monitoring the mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and electroencephalogram double spectrum index (BIS), using 20G venous indwelling needle to open the right upper limb vein and infusion of sodium lactate Ringer's solution. Before induction, the B1~B4 group was static, respectively. Drop Bhutto enphine 12.5 mu g/kg, 15 mu g/kg, 17.5 mu g/kg and 20 mu g/kg, D1~D4 group static drops of zocin 0.075 mg/kg, 0.1 mg/kg, 0.125 mg/kg and 0.15 mg/kg.B5, and D5 two group as control group, both drip and other volume physiological saline, which stipulate that the drug delivery between each drug is 30 s. After giving the experimental drugs, each group of 2 min is intravenously injected etomidate 0.3 G/kg, and the time of injection was 1min. After the injection, we immediately began to observe and record the number and intensity of myoclonus in the B, D two groups. The observation time of each group was 2 min. At the same time, the patients were asked if there was an injection pain at the same time, and the time before the induction of general anesthesia (T_0) was recorded and 2 MI after the experimental drug was given. At the time of n (T_1) and 2 min (T_2) time after intravenous etomidate, the values of MAP, HR, SpO2 and BIS at each time point were measured at each time point. The concentrations of potassium in venous blood were measured in each group of patients before and before the induction of general anesthesia (T_0) and at the 5 min (T_3) at the endotracheal intubation. The occurrence of adverse reactions such as dizziness, nausea and vomiting were observed and recorded. Results in group B, the incidence of myoclonus was 33%, 10%, 10%, 10%. Compared with group B5, the incidence and intensity of myoclonus in group B1, B2, B3, B4 four were significantly lower, and the difference was statistically significant (P0.05), B2, B3, B4 three, compared with the B1 group, there was no statistically significant difference. Difference (P0.05).B2 was the least.B1, B2, B3, B4, B5 five subgroups of B3 and B4 two groups, and the incidence of injection pain in patients was 17%, 10%, 10%, 7%, 20%. There was no statistically significant difference in the incidence and intensity of injection pain in the subgroups of the subgroups (P0.05).T_0, and there was no statistical difference between the T_1 and the five subgroups (P0.05), at the time of T_1, the BIS value of group B4 was lower than that of the other four groups, and the difference was statistically significant (P0.05), T_0, and T_2 time of the five subgroups had no statistical significance (P0.05).D group, and the incidence of myoclonus in each subgroup was 43%, 20%, 20%, 20%, and 70%. compared with the D5 group, and the incidence and strength of the four groups of myoclonus The difference was statistically significant (P0.05), D2, D3, D4 three and D1 group were statistically significant (P0.05), D2, D3, D4 three groups had no significant difference (P0.05).D2 and D3, five subgroups of adverse reactions were 13%, 13%, 10%, 7%, 20%, respectively. There was no significant difference in the incidence and intensity of injection pain in patients (P0.05).T_0, T_1 and T_2 at the time of MAP, HR, SpO2, BIS value difference was not statistically significant (P0.05).B2 and D2 group, there was no significant difference in the incidence and intensity of myoclonus (P0.05); the incidence and intensity of injection pain in the two groups had no statistical significance. .T_0, T_1, and T_2 time 2 groups of patients with MAP, HR, SpO2, BIS values were not statistically significant (P0.05).T_3 and T_0 compared, no myoclonus (myoclonus intensity 0) and 1 and 2 stage myoclonus of patients with venous blood potassium concentration did not change significantly (P0.05); there are severe myoclonus (3 levels of myoclonus strength 3) concentration of venous blood potassium concentration Significant increase (P0.05). Conclusion the concentration of blood potassium in patients with severe myoclonus will increase, and some patients have muscle soreness. The pre intravenous injection of Bhutto enphine 15 mu g/kg and 12.5 mu g/kg, 17.5 u g/kg, 20 mu g/kg Bhutto enphine can be more safe and effective to inhibit myoclonus caused by intravenous etomidate; pre intravenous injection. Dezocin 0.100 mg/kg is safer and more effective than 0.075 mg/kg, 0.125 mg/kg, 0.150 mg/kg, and effectively inhibits the occurrence of myoclonus. There is no significant difference in the inhibition of myoclonus by pre intravenous injection of Bhutto eno 15 UX 0.100mg/kg to dezocin 0.100mg/kg, and fewer adverse reactions caused by two kinds of drugs of these two doses, and There was no difference in the effects of the two on circulation and respiratory system.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R614.2
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