本文關(guān)鍵詞： 氟比洛芬酯 右美托咪定 瑞芬太尼 痛覺(jué)過(guò)敏　出處：《吉林大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究背景:瑞芬太尼因具有起效快、藥效強(qiáng)、可控性高、重復(fù)和持續(xù)輸注無(wú)蓄積等理想麻醉藥物的諸多優(yōu)點(diǎn),臨床應(yīng)用普遍。但由于其獨(dú)特的超短效代謝特性,高劑量或者長(zhǎng)時(shí)間應(yīng)用可使病人產(chǎn)生痛覺(jué)過(guò)敏。氟比洛芬酯和右美托咪定分別是常用的鎮(zhèn)痛、鎮(zhèn)靜藥物,二者防止痛覺(jué)過(guò)敏的機(jī)制不同,期待聯(lián)合用藥發(fā)揮協(xié)同作用并降低不良反應(yīng)的發(fā)生率。目的:觀(guān)察氟比洛芬酯和右美托咪定聯(lián)合應(yīng)用對(duì)瑞芬太尼麻醉后痛覺(jué)過(guò)敏的效果及影響。方法:選擇ASA分級(jí)Ⅰ或Ⅱ級(jí)擇期行甲狀腺癌根治術(shù)的病人120例,使用計(jì)算機(jī)生成的隨機(jī)數(shù)字表分成四組(n=30)即對(duì)照組:C組;實(shí)驗(yàn)組:F組,D組,F+D組。術(shù)前和術(shù)后0.5h、1h用Von Frey Hair纖毛機(jī)械刺激針?lè)謩e測(cè)量患者的痛閾值。C組病人手術(shù)開(kāi)始時(shí)靜脈注射等容量的0.9%的氯化鈉溶液;F組病人麻醉誘導(dǎo)前10分鐘時(shí)靜脈給予氟比洛芬酯2mg/kg;D組病人麻醉誘導(dǎo)時(shí)靜脈給予右美托咪定1μg/kg(勻速輸注時(shí)間設(shè)定30分鐘);F+D組病人麻醉誘導(dǎo)前10分鐘時(shí)靜脈給予氟比洛芬酯1mg/kg,并在麻醉誘導(dǎo)時(shí),開(kāi)始靜脈給予右美托咪定0.5μg/kg(勻速輸注時(shí)間設(shè)定30分鐘)。靜脈輸注瑞芬太尼0.20μg·kg-1·min-1,根據(jù)Narcotrend 37-64調(diào)整丙泊酚用量。術(shù)畢停藥,送入PACU。結(jié)果:四組病人的年齡、BMI、性別比、ASA分級(jí)、麻醉時(shí)間、拔管時(shí)間、術(shù)中低血壓的發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);同C組比較,F、D、F+D組患者術(shù)后0.5h、1h后手術(shù)部位與非手術(shù)部位皮膚痛閾值下降的發(fā)生率明顯降低(P0.05),F組術(shù)后惡心嘔吐的發(fā)生率升高(P0.05),D組術(shù)中心動(dòng)過(guò)緩(HR45次/min)的發(fā)生率明顯升高(P0.05)。F、D、F+D三組患者術(shù)后0.5h、1h后手術(shù)部位與非手術(shù)部位皮膚痛閾值下降的發(fā)生率之間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。與F組比較,F+D組術(shù)后惡心嘔吐的發(fā)生率降低(P0.05);與D組比較,F+D組術(shù)中心動(dòng)過(guò)緩(HR45次/min)的發(fā)生率明顯降低(P0.05)。結(jié)論:麻醉誘導(dǎo)前10分鐘時(shí)靜脈給予氟比洛芬酯1mg/kg,并在麻醉誘導(dǎo)時(shí),靜脈給予右美托咪定0.5μg/kg(勻速輸注時(shí)間設(shè)定30分鐘),可有效防止瑞芬太尼麻醉后產(chǎn)生的痛覺(jué)過(guò)敏,不影響拔管時(shí)間,且降低麻醉藥物不良反應(yīng),臨床上值得推薦。
[Abstract]:Background: remifentanil has rapid onset, high efficacy, high controllability, repeated and continuous infusion of non ideal anesthetic advantages accumulation, clinical application of common. But because of its unique ultra short acting metabolic properties, high dose or long time application can make the patient produces hyperalgesia. Flurbiprofen and right dexmedetomidine is commonly used analgesic, sedative drugs, two mechanism to prevent hyperalgesia, look forward to the combination synergistic effect and reduce the incidence of adverse reaction. Objective: To observe the effect of flurbiprofen axetil and dexmedetomidine combined application of hyperalgesia after remifentanil anesthesia and its effect. Methods: ASA grade I or II undergoing resection of thyroid cancer patients 120 cases, randomly divided into four groups using a computer-generated (n=30): control group: C group; experimental group: F group, D group, F+D group. The preoperative and postoperative 0 .5h, 1H Von Frey Hair cilia mechanical stimulation pain threshold needle were measured in group.C patients, surgical patients with Sodium Chloride Solution 0.9% intravenous injection capacity at the beginning; 10 minutes before induction of intravenous flurbiprofen axetil 2mg/kg group F patients during induction of anesthesia; intravenous dexmedetomidine anesthesia 1 g/kg patients (D group constant infusion time set 30 minutes); 10 minutes before induction of intravenous flurbiprofen axetil 1mg/kg group F+D anesthesia, and during anesthesia induction, start intravenous dexmedetomidine 0.5 g/kg (constant infusion time set 30 minutes). Intravenous infusion of remifentanil 0.20 G - kg-1 - min-1, according to Narcotrend 37-64 to adjust the dosage of propofol. Postoperative withdrawal into the PACU. results: four groups of patient's age, sex ratio, BMI, ASA grade, anesthesia time, extubation time, there was no significant difference in the incidence of intraoperative hypotension (P0.05); group C ratio 杈，

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