婦科腹腔鏡手術(shù)中芬太尼應(yīng)用的優(yōu)化方案探討
發(fā)布時(shí)間：2018-10-08 15:50
【摘要】：目的 觀察不同劑量芬太尼復(fù)合丙泊酚在圍手術(shù)期間應(yīng)用的臨床效果，優(yōu)化婦科腹腔鏡手術(shù)的麻醉方案。 方法 選擇擇期行腹腔鏡下卵巢囊腫剝除手術(shù)患者60例，體重指數(shù)為18～25kg/m2，ASA分級(jí)I級(jí)。采用隨機(jī)數(shù)字表法，，將患者分為A、B、C三組，每組20例，分別在誘導(dǎo)時(shí)給予芬太尼4μg/kg、6μg/kg、8μg/kg。靶控輸注3.0μg/ml丙泊酚，同時(shí)分別靜脈注射誘導(dǎo)劑量的芬太尼，待患者入睡后，靜脈注射維庫溴銨0.1mg/kg，3min后行氣管內(nèi)插管。插管后調(diào)整丙泊酚血漿靶控濃度至2.5μg/ml，術(shù)中維持此濃度不變。手術(shù)開始前追加芬太尼4μg/kg，根據(jù)手術(shù)需要間隔30min追加維庫溴銨0.02～0.06mg/kg。術(shù)中MAP或HR基礎(chǔ)值120%時(shí)給予芬太尼1μg/kg。MAP 基礎(chǔ)值80%時(shí)給予間羥胺0.2mg。HR 50次/分，給予阿托品0.5mg。手術(shù)結(jié)束達(dá)到拔管標(biāo)準(zhǔn)后拔出氣管導(dǎo)管。記錄下面不同時(shí)間點(diǎn)的MAP、HR和BIS：基礎(chǔ)值（T0）、誘導(dǎo)到插管前的最低值（T1）、插管后5min內(nèi)的最高值（T2）、手術(shù)開始后5min內(nèi)的最高值（T3）、腹腔探查后5min內(nèi)的最高值（T4）、拔管后5min內(nèi)的最高值（T5）。記錄患者的呼之睜眼時(shí)間和拔管時(shí)間。記錄手術(shù)期間丙泊酚、芬太尼和血管活性藥的使用情況。記錄患者拔管后5min的呼吸頻率、Prince-Henry疼痛評(píng)分、Steward蘇醒評(píng)分和Riker躁動(dòng)評(píng)分以及納洛酮的使用情況。術(shù)后6h隨訪病人有無惡心嘔吐、呼吸抑制（吸空氣時(shí)SpO290%）及術(shù)中知曉。 結(jié)果 （1）三組患者的MAP和HR在誘導(dǎo)后均低于基礎(chǔ)值，拔管后高于基礎(chǔ)值，但組間比較差異無統(tǒng)計(jì)學(xué)意義（P0.05）。插管后A組的HR明顯高于基礎(chǔ)值，C組低于基礎(chǔ)值，差異有統(tǒng)計(jì)學(xué)意義（P 0.05）；B組和C組的MAP低于A組，C組低于B組，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。手術(shù)開始后，B組和C組的MAP和HR均低于基礎(chǔ)值和A組，C組的SBP和HR低于B組，差異有統(tǒng)計(jì)學(xué)意義（P 0.05）。腹腔探查后，A組和B組的MAP高于基礎(chǔ)值，B組和C組的MAP和HR低于A組，差異有統(tǒng)計(jì)學(xué)意義（P 0.05）。 （2）三組患者麻醉用藥后BIS均明顯低于基礎(chǔ)值（P0.05），拔管后組間比較差異無統(tǒng)計(jì)學(xué)意義（P0.05）。B組和C組誘導(dǎo)后到腹腔探查后BIS均明顯低于A組，C組誘導(dǎo)和插管后BIS明顯低于B組，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 （3）三組患者術(shù)中阿托品和丙泊酚使用情況無統(tǒng)計(jì)學(xué)意義（P0.05）。B組和C組芬太尼使用總量大于A組， C組芬太尼使用總量大于B組，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。B組和C組術(shù)中追加芬太尼的例數(shù)明顯少于A組（P 0.05）。C組使用間羥胺的例數(shù)多于A組和B組（P0.05）。 （4）三組患者術(shù)后呼之睜眼時(shí)間和拔管時(shí)間、疼痛評(píng)分、納洛酮的使用情況及惡心嘔吐的發(fā)生率比較無統(tǒng)計(jì)學(xué)意義（P0.05）。與A組相比，B組和C組術(shù)后躁動(dòng)評(píng)分、呼吸頻率降低（P 0.05）。C組的蘇醒評(píng)分低于B組（P 0.05），三組患者術(shù)后隨訪均無術(shù)中知曉。 結(jié)論 本研究觀察了在中青年婦科腹腔鏡手術(shù)時(shí)，丙泊酚靶控輸注復(fù)合不同劑量的芬太尼在圍手期應(yīng)用的臨床效果。本研究分別以芬太尼4μg/kg、6μg/kg、8μg/kg復(fù)合丙泊酚3.0μg/ml誘導(dǎo)，手術(shù)前追加芬太尼4μg/kg，術(shù)中維持丙泊酚靶控濃度在2.5μg/ml。芬太尼4μg/kg誘導(dǎo)不能有效的抑制插管引起的HR和BIS升高，術(shù)中追加芬太尼的例數(shù)明顯增多，術(shù)后病人容易發(fā)生躁動(dòng)。芬太尼8μg/kg誘導(dǎo)可以有效的抑制插管反應(yīng)，術(shù)中病人血壓和HR較低，但麻醉期間使用間羥胺的例數(shù)增多，術(shù)后容易造成病人鎮(zhèn)靜過度。以芬太尼6μg/kg誘導(dǎo)，可以更好的保持血流動(dòng)力學(xué)的穩(wěn)定，術(shù)中追加藥物少，術(shù)后蘇醒質(zhì)量高，是婦科腹腔鏡手術(shù)的最優(yōu)方案。
[Abstract]:Purpose Objective To observe the clinical effect of different doses of fentanyl and propofol in perioperative period, and to optimize the anesthesia of gynecological laparoscopic surgery. Programme Methods 60 patients with ovarian cyst undergoing laparoscopic ovarian cyst were selected. The body mass index was 18 ~ 25kg/ m2. ASA grade I. The patients were divided into three groups: A, B and C, 20 patients in each group, 4 ug/ kg fentanyl and 6 ug/ k respectively. g, 8. mu.g/ kg. Target-controlled infusion of 3. 0. m u.g/ ml of propylated phenol, at the same time, IV-induced dose of fentanyl, respectively, after the patient's sleep, intravenous vitamin B bromide 0. 1mg/ kg, 3mi n, after intubation, the plasma target control concentration of propylated hydroxyphenol is adjusted to 2.5. mu.g/ ml, In order to maintain this concentration, fentanyl 4. mu.g/ kg was added prior to the start of the operation, and the dimension library was added to 0. 02 ~ 0 according to the required interval of 30min. When MAP or HR basal value in operation was 120%, fentanyl was given 1 ug/ kg. When MAP base value was 80%, m-hydroxyamine was given to 0. 2mg. HR 50 times/ min. Atropine 0. 5mg. The end of the operation reached the pull-out standard. After calibration, pull out the endotracheal tube. Record MAP, HR, and BIS of different time points below: Base value (T0), the lowest value (T1) before intubation, the highest value (T2) within 5min after intubation, the highest value within 5min after operation (T3), and 5min after abdominal cavity exploration Maximum value (T4), within 5min after decannulation Maximum value (T5). Record the patient's wide open Eye time and decannulation time. During the operation of the procedure, propofol, fentanyl and blood vessels were recorded. Use of active drugs. Record the respiratory rate, Prince-Henry pain score, Steward wake-up score and Riker agitation score for 5min after extubation of the patient. Use of naloxone. 6-hour postoperative follow-up for patients with nausea and vomiting, respiratory depression (SpO 29 at suction) 0% Results (1) The MAP and HR of the three groups were lower than the underlying values after induction and were higher than the underlying values after extubation, but the difference between the groups was poor. In group B and group C, MAP was lower than group A and group C was lower than group B. The MAP and HR of group B and group C were lower than those in group A and group C after operation. MAP and HR of group A and group B were lower than that of group A. There was no significant difference in BIS between group B and group C (P0.05). BIS was significantly lower in group C than in group B after induction and intubation. There was no significant difference between group and group (P <0.05). (3) There was no significant difference in the use of Atropine and Propool in three groups (P0.05). The total amount of fentanyl in group C was higher than that in group A, and the difference was statistically significant (P0.05). The number of fentanyl was significantly lower than that in group A (P 0.05). The number of hydroxyamines was more than that in group A and group B (P0.05). The incidence of nausea and vomiting was not statistically significant (P0.05). and the recovery score of group C was lower than B in group C. Group (P 0.05) There was no intraoperative awareness of the follow-up of three groups of patients. Conclusion This study has observed the operation of laparoscopic surgery in young and middle-aged patients. In this study, fentanyl 4. mu.g/ kg, 6. mu.g/ kg, 8. mu.g/ kg of composite propylated hydroxyphenol 3.0. mu.g/ ml were induced, and prior to the operation. In the operation, the concentration of the target control was 2.5. m u.g/ ml. The HR and BI induced by intubation could not be effectively inhibited by fentanyl 4. m u.g/ kg. The increase of S, the number of additional fentanyl in operation increased significantly, and the patients were prone to mania after operation. Fentanyl 8 ug/ kg could effectively inhibit the intubation response, and the blood pressure and HR of patients were lower during operation. but the number of hydroxyamines used during anesthesia is increased, so that the patient is prone to sedation and excessive sedation after operation, and the fentanyl 6. m u.g/ kg can be used for better maintaining the stability of hemodynamics,
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614
本文編號(hào)：2257344
[Abstract]:Purpose Objective To observe the clinical effect of different doses of fentanyl and propofol in perioperative period, and to optimize the anesthesia of gynecological laparoscopic surgery. Programme Methods 60 patients with ovarian cyst undergoing laparoscopic ovarian cyst were selected. The body mass index was 18 ~ 25kg/ m2. ASA grade I. The patients were divided into three groups: A, B and C, 20 patients in each group, 4 ug/ kg fentanyl and 6 ug/ k respectively. g, 8. mu.g/ kg. Target-controlled infusion of 3. 0. m u.g/ ml of propylated phenol, at the same time, IV-induced dose of fentanyl, respectively, after the patient's sleep, intravenous vitamin B bromide 0. 1mg/ kg, 3mi n, after intubation, the plasma target control concentration of propylated hydroxyphenol is adjusted to 2.5. mu.g/ ml, In order to maintain this concentration, fentanyl 4. mu.g/ kg was added prior to the start of the operation, and the dimension library was added to 0. 02 ~ 0 according to the required interval of 30min. When MAP or HR basal value in operation was 120%, fentanyl was given 1 ug/ kg. When MAP base value was 80%, m-hydroxyamine was given to 0. 2mg. HR 50 times/ min. Atropine 0. 5mg. The end of the operation reached the pull-out standard. After calibration, pull out the endotracheal tube. Record MAP, HR, and BIS of different time points below: Base value (T0), the lowest value (T1) before intubation, the highest value (T2) within 5min after intubation, the highest value within 5min after operation (T3), and 5min after abdominal cavity exploration Maximum value (T4), within 5min after decannulation Maximum value (T5). Record the patient's wide open Eye time and decannulation time. During the operation of the procedure, propofol, fentanyl and blood vessels were recorded. Use of active drugs. Record the respiratory rate, Prince-Henry pain score, Steward wake-up score and Riker agitation score for 5min after extubation of the patient. Use of naloxone. 6-hour postoperative follow-up for patients with nausea and vomiting, respiratory depression (SpO 29 at suction) 0% Results (1) The MAP and HR of the three groups were lower than the underlying values after induction and were higher than the underlying values after extubation, but the difference between the groups was poor. In group B and group C, MAP was lower than group A and group C was lower than group B. The MAP and HR of group B and group C were lower than those in group A and group C after operation. MAP and HR of group A and group B were lower than that of group A. There was no significant difference in BIS between group B and group C (P0.05). BIS was significantly lower in group C than in group B after induction and intubation. There was no significant difference between group and group (P <0.05). (3) There was no significant difference in the use of Atropine and Propool in three groups (P0.05). The total amount of fentanyl in group C was higher than that in group A, and the difference was statistically significant (P0.05). The number of fentanyl was significantly lower than that in group A (P 0.05). The number of hydroxyamines was more than that in group A and group B (P0.05). The incidence of nausea and vomiting was not statistically significant (P0.05). and the recovery score of group C was lower than B in group C. Group (P 0.05) There was no intraoperative awareness of the follow-up of three groups of patients. Conclusion This study has observed the operation of laparoscopic surgery in young and middle-aged patients. In this study, fentanyl 4. mu.g/ kg, 6. mu.g/ kg, 8. mu.g/ kg of composite propylated hydroxyphenol 3.0. mu.g/ ml were induced, and prior to the operation. In the operation, the concentration of the target control was 2.5. m u.g/ ml. The HR and BI induced by intubation could not be effectively inhibited by fentanyl 4. m u.g/ kg. The increase of S, the number of additional fentanyl in operation increased significantly, and the patients were prone to mania after operation. Fentanyl 8 ug/ kg could effectively inhibit the intubation response, and the blood pressure and HR of patients were lower during operation. but the number of hydroxyamines used during anesthesia is increased, so that the patient is prone to sedation and excessive sedation after operation, and the fentanyl 6. m u.g/ kg can be used for better maintaining the stability of hemodynamics,
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614
【共引文獻(xiàn)】
相關(guān)碩士學(xué)位論文 前1條
1 張霞;芬太尼在腹腔鏡膽囊切除術(shù)中優(yōu)化應(yīng)用的探討[D];蘇州大學(xué);2014年
本文編號(hào)：2257344
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