【摘要】：研究目的： 數(shù)字剪影血管造影能清楚地顯示頸內(nèi)動(dòng)脈、椎基底動(dòng)脈、顱內(nèi)大血管及大腦半球的血管圖像，還可測定動(dòng)脈的血流量，目前已被應(yīng)用于腦血管病檢查，特別是對于動(dòng)脈瘤、動(dòng)靜脈畸形等定性定位診斷，更是最佳的診斷手段。部分病人的恐懼心理，或者嚴(yán)重顱腦損傷的患者煩躁、不配合使檢查過程難以進(jìn)行，并且造成患者心理及生理上的不適感。本文目的在于研究應(yīng)用鹽酸右美托咪定在DSA檢查中對患者進(jìn)行適當(dāng)?shù)逆?zhèn)靜，觀察右美托咪定應(yīng)用于神經(jīng)外科患者DSA檢查時(shí)的鎮(zhèn)靜效果,使之消除患者緊張恐懼心理，使患者的檢查過程更加舒適，使躁動(dòng)患者能夠配合檢查，縮短檢查過程所需時(shí)間，并提高準(zhǔn)確性，為患者的病情診斷提供更有效、準(zhǔn)確的依據(jù)。 研究方法： 選擇2013年8月-2013年12月在吉林大學(xué)第二醫(yī)院神經(jīng)外科需要行DSA檢查的患者60例。采用隨機(jī)雙盲的方法分為A：右美托咪定組，B：咪達(dá)唑侖組，C：對照組,每組患者20例。三組患者在性別、年齡、體重方面無顯著性差異。 A組入選患者給予右美托咪定負(fù)荷劑量1μg/kg，負(fù)荷劑量輸注時(shí)間設(shè)置為15分鐘。負(fù)荷量完畢后，再0.1-0.7μg/kg/h維持。在手術(shù)結(jié)束10分鐘前停藥。 B組入選患者后經(jīng)靜脈咪達(dá)唑侖組首先給予0.05mg/kg咪達(dá)唑侖負(fù)荷劑量,注藥時(shí)間1min,再0.02～0.1mg/kg/h的速度維持,老年患者適當(dāng)降低用量。手術(shù)結(jié)束前10分鐘停藥。 C組入選患者入導(dǎo)管室后經(jīng)靜脈給予生理鹽水5ml。 三組患者待手術(shù)開始時(shí)，術(shù)者使用2%的利多卡因?qū)π枰┐滩课恍芯植拷䴘櫬樽怼?分別記錄入選患者給藥前(T0)、給藥后5min(T1)、造影前(T2)、造影局麻置管時(shí)(T3)、置管后10min(T4),造影結(jié)束后5min (T5）的血壓（BP）、心率（HR）、脈搏血氧飽和度（SPO2）,并記錄各組患者各時(shí)間點(diǎn)的鎮(zhèn)痛、鎮(zhèn)靜程度。所有實(shí)驗(yàn)數(shù)據(jù)統(tǒng)計(jì)分析采用SPSS21.0軟件包，以P0.05為檢驗(yàn)水準(zhǔn)，說明統(tǒng)計(jì)學(xué)意義。 結(jié)果： 三組病例T0-T2時(shí)段MAP無明顯差異。對照組MAP從T3開始明顯升高，持續(xù)至T5檢查結(jié)束。右美托咪定組與咪達(dá)唑侖組無MAP的明顯上升，右美托咪定組較咪達(dá)唑侖組MAP波動(dòng)更小。 T0時(shí)三組病例HR無差異，T1-T4對照組HR持續(xù)升高，至T5略有下降趨勢，但與T0相比升高明顯。右美托咪定組與咪達(dá)唑侖組心率變化不明顯，兩實(shí)驗(yàn)組無明顯差異。 Ramsay評分在T0時(shí)三組間的差異無統(tǒng)計(jì)學(xué)意義，而在T1-T5時(shí)差異顯著，且右美托咪定與咪達(dá)唑侖組的鎮(zhèn)靜評分顯著低于對照組。T2、T5時(shí)右美托咪定組略高于咪達(dá)唑侖組，，P0.05。 VAS評分在T0時(shí)三組組間的差異無統(tǒng)計(jì)學(xué)意義，，而在T1-T5時(shí)差異顯著，且兩實(shí)驗(yàn)組鎮(zhèn)痛評分顯著低于對照組。T3時(shí)右美托咪定組較咪達(dá)唑侖組低，P=0.047。 對照組無呼吸抑制，T0時(shí)三組無差異，T1-T4兩實(shí)驗(yàn)組與對照組差異明顯，P0.01。T5時(shí)無差異，P0.05。T1-T3時(shí)咪達(dá)唑侖組略高于右美托咪定組。 對照組合作度相對較差。 不良反應(yīng)方面，對照組高血壓與心動(dòng)過速發(fā)生率較高，P0.01。其他方面無明顯差異。 結(jié)論： 右美托咪定與咪達(dá)唑侖應(yīng)用于神經(jīng)外科DSA檢查的患者時(shí)能夠起到良好的鎮(zhèn)靜作用，不良反應(yīng)少，并且與咪達(dá)唑侖相比，右美托咪定具有一定的鎮(zhèn)痛效果，呼吸道抑制輕微，患者血流動(dòng)力學(xué)更加平穩(wěn)。
[Abstract]:Research purposes:
Digital silhouette angiography can clearly display the images of internal carotid artery, vertebrobasilar artery, intracranial large vessels and cerebral hemisphere, and can also measure the blood flow of arteries. It has been used in the examination of cerebrovascular diseases, especially for qualitative localization diagnosis of aneurysms, arteriovenous malformations and so on. The purpose of this study was to investigate the sedation effect of dexmedetomidine hydrochloride in DSA and to observe the sedation effect of dexmedetomidine hydrochloride in DSA for neurosurgical patients. The effect is to eliminate the patient's nervousness and fear, make the patient's examination process more comfortable, so that restless patients can cooperate with the examination, shorten the time required for the examination process, and improve the accuracy, so as to provide more effective and accurate basis for the diagnosis of the patient's condition.
Research methods:
Sixty patients who needed DSA examination in neurosurgery department of the Second Hospital of Jilin University from August 2013 to December 2013 were randomly divided into A: dexmedetomidine group, B: midazolam group and C: control group. There were no significant differences in sex, age and weight among the three groups.
Patients in group A were given dexmedetomidine at a loading dose of 1 ug/kg for 15 minutes and then maintained at a loading dose of 0.1-0.7 ug/kg/h.
In group B, the loading dose of midazolam was 0.05 mg/kg, the injection time was 1 minute, and the speed was maintained at 0.02-0.1 mg/kg/h. The dosage of midazolam was reduced appropriately in the elderly patients.
Patients in group C were given intravenous saline after intravenous infusion into the catheter room of group 5ml..
At the beginning of surgery, the surgeons in the three groups used 2% lidocaine for local infiltration anesthesia at the needle site.
The blood pressure (BP), heart rate (HR) and pulse oxygen saturation (SPO2) were recorded before administration (T0), 5 minutes after administration (T1), before angiography (T2), during local anesthesia (T3), 10 minutes after angiography (T4), 5 minutes after angiography (T5), and the analgesia and sedation were recorded. All experimental data were analyzed by SPSS21.0 software. P0.05 is used as a test level to illustrate the statistical significance.
Result:
There was no significant difference in MAP between the three groups at T0-T2. MAP in the control group increased significantly from T3 until the end of T5. There was no significant increase in MAP between dexmedetomidine and midazolam groups. MAP fluctuated less in dexmedetomidine group than midazolam group.
There was no difference in HR between the three groups at T0. HR in the T1-T4 control group continued to increase until T5 decreased slightly, but increased significantly compared with T0. There was no significant difference in HR between dexmedetomidine group and midazolam group.
There was no significant difference in Ramsay score between the three groups at T0, but significant difference at T1-T5. The sedation score of dexmedetomidine and midazolam group was significantly lower than that of the control group. T2, T5, dexmedetomidine group was slightly higher than midazolam group, P 0.05.
There was no significant difference in VAS score between the three groups at T0, but significant difference at T1-T5. The analgesic score of the two experimental groups was significantly lower than that of the control group. At T3, dexmedetomidine group was lower than midazolam group, P = 0.047.
There was no respiratory depression in the control group, and there was no difference among the three groups at T0. There was no difference between the two experimental groups at T1-T4 and the control group at P 0.01.T5. Midazolam group was slightly higher than dexmedetomidine group at P 0.05.T1-T3.
The control group was relatively poor.
In the side effects, the incidence of hypertension and tachycardia in the control group was higher than that in the control group (P 0.01).
Conclusion:
Compared with midazolam, dexmedetomidine has a certain analgesic effect, slight respiratory depression and more stable hemodynamics.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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