全身麻醉中兒童夢境的影響因素以及右美托咪定對其影響
發(fā)布時間：2018-09-17 08:13
【摘要】：目的 探討全身麻醉中兒童夢境的影響因素同時研究右美托咪定對兒童在全身麻醉期間對夢的影響。方法 1擬行骨科手術患兒200例,性別不限,ASA分級Ⅰ級,年齡5~12歲,體重指數(shù)15.2~18.1 kg/m2。PACU期間患兒蘇醒、且定向力恢復時,采用改良Brice問卷調查夢的發(fā)生情況,如果有夢發(fā)生,采用Likert評分對夢境(夢境中的情緒、聲音、動作,對夢的記憶程度)進行調查。2擬行骨科手術患兒400例,性別不限,ASA分級Ⅰ級,年齡5~12歲,體重指數(shù)15.2~18.1 kg/m2,根據(jù)計算機隨機生成數(shù)字順序,根據(jù)數(shù)字的奇偶性隨機分為2組(n=200):對照組(C組)和右美托咪定組(D組)。D組麻醉誘導前經(jīng)10 min靜脈輸注右美托咪定負荷量0.5μg/kg,隨后以0.5μg·kg-1·h-1的速率靜脈維持,C組給予等容量生理鹽水。入PACU后待患兒蘇醒、且定向力恢復時,采用改良Brice問卷調查夢的發(fā)生情況,采用Likert評分對夢境內容(夢境中的情緒、聲音、動作及對夢的記憶程度)進行調查。結果 1兒童在全身麻醉中夢境發(fā)生率是22%。夢者的年齡與非夢者年齡相比較小(OR 0.77,OR的95%可信區(qū)間0.64-0.93),呼之睜眼時間(OR 0.91,OR的95%可信區(qū)間0.85-0.98)和定向力恢復時間(OR 0.93,OR的95%可信區(qū)間0.88-0.99)夢者相對較短,接受調查時的Narcotrend值較高(OR 1.13,OR的95%可信區(qū)間1.01-1.27),有統(tǒng)計學差異(P0.01),同時我們發(fā)現(xiàn)夢者平時做夢情況較非夢者要更為多見,有統(tǒng)計學意義(P0.05)。2 D組的夢的發(fā)生率9%,低于C組的發(fā)生率22%(OR 0.351,95%的可信區(qū)間0.195-0.632,;P0.01)。與C組比較,D組夢發(fā)生率降低,對夢境記憶程度評分降低(P0.05),夢境中情緒、聲音和動作評分差異無統(tǒng)計學意義(P0.05)。同時蘇醒期RAMSAY評分D組高于C組,有統(tǒng)計學意義(P0.05),躁動發(fā)生率D組8%明顯低于C組30%,有統(tǒng)計學意義(P0.05)。兩組術后滿意度調查相比,D組的滿意度高于C組,有統(tǒng)計學意義(P0.01).結論 總之,年齡越小、平時做夢頻繁、蘇醒期鎮(zhèn)靜深度越淺可能會報告出更多的夢境發(fā)生的情況;麻醉過程中發(fā)生夢境并不影響對手術過程的滿意度;右美托咪定在兒童全身麻醉手術中應用可以使麻醉中的夢境發(fā)生率下降,但并不影響夢境中的內容,大多數(shù)都是積極的、愉快的;右美托咪定可以使術后蘇醒躁動減少,患兒滿意度上升。
[Abstract]:Objective to investigate the influencing factors of children's dreams during general anesthesia and to study the effects of dexmetomidine on children's dreams during general anesthesia. Methods 1Twenty two hundred children undergoing orthopedic surgery were enrolled in this study. The age was 5 to 12 years old, and the body mass index (BMI) was 15.21.When the recovery of orientation, the modified Brice questionnaire was used to investigate the occurrence of the dream, if there was a dream. Likert score was used to investigate 400 cases of children who planned orthopedic surgery (mood, voice, movement and memory of dreams). The age was 512 years old. The body mass index (BMI) of 15.2g 18.1 kg/m2, was randomly generated by the computer in numerical order, According to the number of parity, they were randomly divided into two groups: control group (group C) and dexmetomidine group (group D). Group D received intravenous infusion of dexmetomidine at a rate of 0.5 渭 g / kg for 10 min before anesthesia induction, then maintained the same volume of saline in group C at a rate of 0.5 渭 g / h ~ (-1). After entering PACU, the dream content (mood, voice, movement and memory level of dream) was investigated by modified Brice questionnaire. The content of dream (mood, voice, movement and memory of dream) was investigated by using modified Brice questionnaire. Results 1 the incidence of dreams in children under general anesthesia was 22. The age of dreamers was younger than that of non-dreamers (95% confidence interval of OR 0.77OR 0.64-0.93), the time of eye opening (95% confidence interval of OR 0.91 OR was 0.85-0.98) and the recovery time of orientation (95% confidence interval of OR 0.93OR 0.88-0.99). The Narcotrend value was higher (95% CI 1.01-1.27 of OR 1.13OR), and there was statistical difference (P0.01). At the same time, we found that the dreamers were more likely to dream than the non-dreamers. The incidence of dreams in group D was significantly lower than that in group C (P 0.05), which was lower than that in group C (OR 0.35195% CI 0.195-0.632P0.01). Compared with group C, the incidence of dreams in group D was lower, the score of dream memory was lower (P0.05), and there was no significant difference in scores of emotion, voice and action in dreams (P0.05). At the same time, RAMSAY score in group D was significantly higher than that in group C (P0.05). The incidence of restlessness in group D was significantly lower than that in group C (P 0.05). Compared with group D, the satisfaction of group D was higher than that of group C (P 0.01). Conclusion in short, the younger the age, the more frequent dreams, the lower the sedation depth during the recovery period, the more the occurrence of dreams may be reported, and the occurrence of dreams during anesthesia does not affect the satisfaction of the operation process. The use of dexmetomidine in children undergoing general anesthesia can reduce the incidence of dreams in anesthesia, but it does not affect the content of dreams, most of them are positive and pleasant, and dexmetomidine can reduce postoperative recovery and restlessness. Children's satisfaction increased.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R726.1
本文編號：2245267
[Abstract]:Objective to investigate the influencing factors of children's dreams during general anesthesia and to study the effects of dexmetomidine on children's dreams during general anesthesia. Methods 1Twenty two hundred children undergoing orthopedic surgery were enrolled in this study. The age was 5 to 12 years old, and the body mass index (BMI) was 15.21.When the recovery of orientation, the modified Brice questionnaire was used to investigate the occurrence of the dream, if there was a dream. Likert score was used to investigate 400 cases of children who planned orthopedic surgery (mood, voice, movement and memory of dreams). The age was 512 years old. The body mass index (BMI) of 15.2g 18.1 kg/m2, was randomly generated by the computer in numerical order, According to the number of parity, they were randomly divided into two groups: control group (group C) and dexmetomidine group (group D). Group D received intravenous infusion of dexmetomidine at a rate of 0.5 渭 g / kg for 10 min before anesthesia induction, then maintained the same volume of saline in group C at a rate of 0.5 渭 g / h ~ (-1). After entering PACU, the dream content (mood, voice, movement and memory level of dream) was investigated by modified Brice questionnaire. The content of dream (mood, voice, movement and memory of dream) was investigated by using modified Brice questionnaire. Results 1 the incidence of dreams in children under general anesthesia was 22. The age of dreamers was younger than that of non-dreamers (95% confidence interval of OR 0.77OR 0.64-0.93), the time of eye opening (95% confidence interval of OR 0.91 OR was 0.85-0.98) and the recovery time of orientation (95% confidence interval of OR 0.93OR 0.88-0.99). The Narcotrend value was higher (95% CI 1.01-1.27 of OR 1.13OR), and there was statistical difference (P0.01). At the same time, we found that the dreamers were more likely to dream than the non-dreamers. The incidence of dreams in group D was significantly lower than that in group C (P 0.05), which was lower than that in group C (OR 0.35195% CI 0.195-0.632P0.01). Compared with group C, the incidence of dreams in group D was lower, the score of dream memory was lower (P0.05), and there was no significant difference in scores of emotion, voice and action in dreams (P0.05). At the same time, RAMSAY score in group D was significantly higher than that in group C (P0.05). The incidence of restlessness in group D was significantly lower than that in group C (P 0.05). Compared with group D, the satisfaction of group D was higher than that of group C (P 0.01). Conclusion in short, the younger the age, the more frequent dreams, the lower the sedation depth during the recovery period, the more the occurrence of dreams may be reported, and the occurrence of dreams during anesthesia does not affect the satisfaction of the operation process. The use of dexmetomidine in children undergoing general anesthesia can reduce the incidence of dreams in anesthesia, but it does not affect the content of dreams, most of them are positive and pleasant, and dexmetomidine can reduce postoperative recovery and restlessness. Children's satisfaction increased.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R726.1
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