【摘要】：目的: 胸主動脈瘤介入手術(shù)中，由于患者意識完全清醒，當(dāng)局麻部位出現(xiàn)鎮(zhèn)痛不全時，導(dǎo)致其緊張、焦慮甚至恐懼等，臨床表現(xiàn)為心率加快、血壓升高,增加心肌耗氧量，從而不利于心肌細(xì)胞氧供需的平衡，因此易出現(xiàn)心絞痛，甚至心肌梗死等嚴(yán)重并發(fā)癥。 方法： 選擇擬行胸主動脈瘤介入手術(shù)患者60例，采用隨機雙盲的方法分為三組（A：右美托咪定組，B：咪達(dá)唑侖組，C：對照組）,每組患者20例。A組泵注右美托咪定負(fù)荷劑量為1μg/kg，勻速輸注15分鐘后負(fù)荷量泵注完畢，以0.1-0.7μg/kg/h的劑量維持泵注；B組患者靜注咪達(dá)唑侖注射液30-40μg/kg；C組患者靜脈給予生理鹽水5ml。分別觀察入手術(shù)室時、用藥后5min、局麻置管時、手術(shù)中、手術(shù)結(jié)束后的血壓、心率、血氧飽和度,并記錄患者的鎮(zhèn)靜程度,遺忘程度以及術(shù)后的心理狀況；記錄在整個手術(shù)過程中出現(xiàn)的不良反應(yīng)，即：心動緩慢(心率50次/min)，心動過速(心率100次/min)，高血壓(收縮壓170mmHg)，低血壓(收縮壓85mmHg)，呼吸抑制(呼吸頻率8次/min)，惡心嘔吐、過敏反應(yīng)等其他特殊不良反應(yīng)。 結(jié)果： 三組組患者年齡、體重、身高、性別差異均無統(tǒng)計學(xué)意義，三組在任一時刻的SPO2和呼吸頻率沒有顯著差異, P0.05。所有患者的SPO2均95%,所有患者在整個過程中的呼吸抑制評分均在1-3分。 A組、B組與C組相比較，在給藥后5min、局麻置管時及手術(shù)中，平均動脈壓均低于C組，差異具有顯著性（P0.05）；A組與B組相比，局麻時A組平均動脈壓低于B組，差異具有顯著性（P0.05）。鎮(zhèn)靜評分： A組、B組與C組相比有非常顯著的差異,（P 0.01）；A組與B組相比，無顯著性差異（P0.05）。 術(shù)中合作度評級：A組、B組與C組相比有非常顯著的差異,（P 0.01）；A組與B組相比，無顯著性差異（P0.05）。 術(shù)后患者對術(shù)中鎮(zhèn)痛、鎮(zhèn)靜效果滿意度評分，A組、B組與C組相比較，差異有統(tǒng)計學(xué)意義（P0.05)，A組與B組比較，差異無統(tǒng)計學(xué)意義（P0.05)。 遺忘程度比較，A組、B組與C組相比較，差異有統(tǒng)計學(xué)意義（P0.05)，A組與B組比較，差異有統(tǒng)計學(xué)意義（P0.05) 不良反應(yīng)的發(fā)生情況,并發(fā)高血壓者：A組、B組與C組相比，，差異具有顯著性，（P0.01）；并發(fā)心動過速者：A組、B組與C組相比，差異具有顯著性，（P0.01）。在心動過緩,低血壓,呼吸抑制,惡心嘔吐,過敏反應(yīng)幾個方面沒有顯著差異。 結(jié)論： 右美托咪定與咪達(dá)唑侖相比，在局部麻醉胸主動脈瘤介入手術(shù)時可以使患者的血液動力學(xué)更穩(wěn)定，不良反應(yīng)發(fā)生率更少。
[Abstract]:Objective: during the interventional operation of thoracic aortic aneurysm, due to the complete consciousness of the patient and the inadequacy of analgesia in the anesthetic area of the authorities, it leads to tension, anxiety and even fear. The clinical manifestations are as follows: the heart rate is increased, the blood pressure is elevated, and so on. The increase of myocardial oxygen consumption is not conducive to the balance of oxygen supply and demand of myocardial cells, so angina pectoris, even myocardial infarction and other serious complications are easy to occur. Methods: sixty patients with thoracic aortic aneurysm undergoing interventional operation were randomly divided into three groups (A: right metometomidine group, B: midazolam group, C: control group), and the patients were randomly divided into three groups (A: right metametramine group, B: midazolam group, C: control group). There were 20 patients in each group. In group A, the dose of right metomidate was 1 渭 g / kg, for 15 minutes, and the dose of 0.1-0.7 渭 g / kg/h was maintained. Group B received intravenously midazolam injection (30-40 渭 g / kg;C) intravenously with normal saline (5 ml). The blood pressure, heart rate, blood oxygen saturation after operation were observed at 5 min after medication and local anaesthesia, and the degree of sedation, amnesia and psychological state after operation were recorded. Adverse reactions were recorded throughout the operation, namely, slow heart rate (heart rate 50 beats / min), tachycardia (heart rate 100 beats / min), hypertension (systolic blood pressure 170mmHg), hypotension (systolic blood pressure 85mmHg). Respiratory inhibition (respiratory rate of 8 / min), nausea, vomiting, anaphylaxis, and other specific adverse reactions. Results: there was no significant difference in age, weight, height and sex among the three groups. There was no significant difference in SPO2 and respiratory rate among the three groups at any time, P 0.05. All patients had 95% SPO2, and all patients had a respiratory inhibition score of 1? 3. Compared with group C, the mean arterial pressure in group A and group B was significantly lower than that in group C at 5 minutes after administration (P0.05), and the mean arterial pressure was significantly lower in group A and group B than in group C (P0.05). Compared with group B, the mean arterial pressure in group A was significantly lower than that in group B during local anesthesia (P0.05). Sedation score: there was no significant difference between group A, group B and group C in, (P 0.01); A group and B group (P0.05). Intraoperative cooperation rating: there was no significant difference between group A, group B and group C in, (P 0.01); A group and B group (P0.05). Postoperative analgesia, sedation effect satisfaction score, A group, B group and C group, the difference was statistically significant (P0.05), A group and B group, the difference was not statistically significant (P0.05). The degree of amnesia, A group, B group and C group, the difference was statistically significant (P0.05), A group and B group, the difference was statistically significant (P0.05) the occurrence of adverse reactions, patients with hypertension: group A, P < 0.05, P < 0.05). There was significant difference between group B and group C (P0.01). Patients with tachycardia: group A, group B and group C, the difference was significant (P0.01). There was no significant difference in bradycardia, hypotension, respiratory inhibition, nausea and vomiting, anaphylaxis. Conclusion: compared with midazolam, right metomidine can make the hemodynamics more stable and the incidence of adverse reactions less in patients with thoracic aortic aneurysm under local anesthesia.
【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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