本文關(guān)鍵詞： 腦氧飽和度 右美托咪定 胸腔鏡手術(shù) 術(shù)后譫妄 s-100β蛋白　出處：《石河子大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討腦氧飽和度監(jiān)測(cè)下右美托咪定對(duì)老年胸腔鏡手術(shù)患者術(shù)后譫妄的發(fā)生率和對(duì)血清s-100β蛋白的影響。為右美托咪定防治老年胸腔鏡手術(shù)術(shù)后譫妄提供臨床參考。方法:選取擇期擬行電視胸腔鏡手術(shù)的老年患者72例,年齡65~75歲,ASA分級(jí)I~Ⅱ級(jí),性別不限。采用隨機(jī)數(shù)字表法分為2組右美托咪定組(D組)和對(duì)照組(C組),每組36例。術(shù)前采用簡(jiǎn)易精神狀態(tài)檢查量表(mini-mental state examination,MMSE)檢查,排除術(shù)前有認(rèn)知功能障礙的患者。D組患者麻醉誘導(dǎo)前給予右美托咪定負(fù)荷劑量0.5μg/kg,輸注時(shí)間15min,然后以0.3~0.5μg/kg/h持續(xù)輸注,至手術(shù)結(jié)束前30min停止;C組以相同方法靜脈注射等容量0.9%氯化鈉注射液。分別記錄2組患者入室后5min(T_0),麻醉誘導(dǎo)前(T_1),氣管插管前(T_2),氣管插管后即刻(T_3),單肺通氣前(T_4),單肺通氣結(jié)束時(shí)(T_5),拔管前(T_6),拔管后5 min(T_7)平均動(dòng)脈壓(mean arterial pressure,MAP)、心率(heart rate,HR)、脈搏血氧飽和度(Pulse Oxygen Saturation,SpO_2)、心電圖(electrocardiogram,ECG)和腦氧飽和度(Cerebral regional oxygen saturation,rSO_2)。術(shù)中連續(xù)監(jiān)測(cè)rSO_2并記錄T_0~T_7各時(shí)間點(diǎn)數(shù)值。并計(jì)算術(shù)中rSO_2的平均值(2rSO)、術(shù)中rSO_2最小值(rSO_2min)和rSO_2較基礎(chǔ)值下降的最大百分?jǐn)?shù)(rSO_2%max)。于麻醉前5 min、術(shù)畢、術(shù)后24h、48h時(shí)分別采集靜脈血測(cè)定s-100β蛋白濃度。于術(shù)后1、2、3d時(shí)采用譫妄評(píng)定方法中文修訂版(Confusion Assessment Method-Chinese reversion,CAM-CR)量表對(duì)兩組患者進(jìn)行術(shù)后譫妄的評(píng)估。結(jié)果:D組患者中有2名發(fā)生術(shù)后譫妄,術(shù)后譫妄發(fā)生率為5%;C組患者有9名發(fā)生術(shù)后譫妄,術(shù)后譫妄發(fā)生率為25%,D組患者術(shù)后譫妄的發(fā)生率明顯低于C組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者術(shù)畢、術(shù)后24 h血清s-100β蛋白水平含量D組明顯低于C組(P0.05);術(shù)畢和術(shù)后48h與麻醉前5min比較兩組患者血清s-100β蛋白均明顯升高(P0.05);兩組rSO_2均在T_5時(shí)比T_0時(shí)下降明顯且C組顯著低于D組(P0.05);D組患者T_3時(shí)MAP明顯低于C組(P0.05),C組患者M(jìn)AP T_3時(shí)比T_0時(shí)刻明顯上升(P0.05);兩組患者HR在T_3時(shí)比T_0時(shí)均有明顯上升(P0.05),SpO_2差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。D組患者的rSO_2較基礎(chǔ)值下降的最大百分?jǐn)?shù)(rSO_2%max)明顯低于C組(P0.05);C組的rSO_2平均值顯著低于D組(P0.05);rSO_2最小值差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:右美托咪定能夠降低老年胸腔鏡手術(shù)患者術(shù)后譫妄的發(fā)生率及降低術(shù)后血清s-100β蛋白的水平,可以改善老年胸腔鏡手術(shù)患者的腦氧代謝。
[Abstract]:Objective:. To investigate the effect of dexmetomidine on postoperative delirium and serum s-100 尾 protein in elderly patients undergoing thoracoscopic surgery under cerebral oxygen saturation monitoring. Clinical references. Methods:. A total of 72 elderly patients undergoing video-assisted thoracoscopic surgery were selected. The age of 65 ~ 75 years old patients with ASA grade I ~ II was not limited. The patients were randomly divided into two groups: right metomidine group (group D) and control group (group C). The mini-mental state examination (MMSE) was performed in 36 patients in each group before operation. Before anesthesia induction, patients in group D were treated with dexmetomidine at a dose of 0.5 渭 g / kg for 15 minutes. Then 0.3 渭 g / kg / h of 0.5 渭 g / kg / h was continuously infused and stopped 30 minutes before the end of the operation. In group C, 0.9% sodium chloride injection of equal volume was injected intravenously with the same method. The patients in two groups were recorded at 5 min after entering the room, before induction of anesthesia, before induction of anesthesia, T1T, and before tracheal intubation. Immediately after tracheal intubation, T _ 3, T _ (4), T _ (5) and T _ (6) at the end of one-lung ventilation. Mean arterial pressure MAPP, heart rate and heart rate were observed 5 min after extubation. Pulse Oxygen saturation (SPO _ 2), electrocardiogram (ECG). And cerebral oxygen saturation (Cerebral regional oxygen saturation). RSO_2 was monitored continuously during operation and the values of T0 / T _ (7) were recorded. The mean value of rSO_2 during operation was calculated (2rso). The maximum percentage of the decrease of rSO_2 and rSO_2 compared with the basic value was max.5min before anaesthesia, 24 hours after operation. The concentration of s-100 尾 protein in venous blood was measured at 48 h after operation. The delirium Assessment Method-Chinese reversion was evaluated by the Chinese version of the revised Chinese version on the 3rd day. Results two patients in group D had postoperative delirium, and the incidence of postoperative delirium was 5%. There were 9 cases of postoperative delirium in group C, the incidence of postoperative delirium in group D was significantly lower than that in group C (P 0.05). The level of serum s-100 尾 protein in group D was significantly lower than that in group C at 24 hours after operation. Compared with 5 min before anesthesia, serum s-100 尾 protein increased significantly in both groups at the end of operation and 48 hours after operation compared with 5 min before anesthesia. RSO_2 in both groups was significantly lower than that in T _ 0 at T5 and P _ (0.05) in group C was significantly lower than that in D group (P < 0.05). The level of MAP in group D was significantly lower than that in group C at the time of MAP T3 compared with that in group C (P 0.05). The HR of both groups was significantly higher than that of T _ 0 at the time of T _ 3 (P 0.05). There was no significant difference in SpO_2 between the two groups (P 0.05). The rSO_2 of group D was significantly lower than that of group C (P 0.05%) than that of group C (P < 0.05), and that of group D was significantly lower than that of group C (P < 0.05). The average value of rSO_2 in group C was significantly lower than that in group D (P 0.05). Conclusion: dexmetomidine can reduce the incidence of postoperative delirium and the level of serum s-100 尾 protein in elderly patients undergoing thoracoscopic surgery. It can improve cerebral oxygen metabolism in elderly patients undergoing thoracoscopic surgery.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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