本文選題：右美托咪定　切入點：咪達唑侖　出處：《河南科技大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過對比右美托咪定與咪達唑侖對老年患者在腰硬聯(lián)合麻醉中的循環(huán)、鎮(zhèn)靜效應以及是否會出現(xiàn)呼吸功能受抑制等方面的影響,研究右美托咪定在用于老年患者腰硬聯(lián)合麻醉中輔助鎮(zhèn)靜的有效性及安全性。方法:選取河南科技大學第一附屬醫(yī)院和南陽醫(yī)專第一附屬醫(yī)院2015年6月~2016年6月?lián)衿谛邢赂共俊⑾轮中g(shù)且采用腰硬聯(lián)合麻醉方式的老年患者80例,男45例,女35例,平均年齡(72.42±5.83)歲,ASAⅠ~Ⅰ級。進入實驗的老年患者按隨機數(shù)字表法分為對照組和實驗組,分別為咪達唑侖組(M組)和右美托咪定組(D組),每組各40例。麻醉效果確切后,M組患者10min內(nèi)予以咪達唑侖以0.05mg/kg靜脈泵入,之后以0.1mg/kg/h的速度靜脈泵注維持,D組患者在10min內(nèi)給予右美托咪定0.5μg/kg靜脈泵入,之后以濃度0.3μg/kg/h持續(xù)靜脈泵注。對2組患者給藥前(T0)、給藥后10min(T1)、20min(T2)、30min(T3)、60min(T4)的有創(chuàng)平均動脈壓(MAP)、心率(HR)、呼吸頻率(RR)、改良警覺/鎮(zhèn)靜視覺評分(OAA/S評分)和血氧飽和度(SpO2)進行觀察比較,并且把這2組病人術(shù)中不良反應的發(fā)生情況和術(shù)后24h隨訪病人對麻醉手術(shù)操作的遺忘程度詳細的記錄下來。結(jié)果:與T0進行對比,發(fā)現(xiàn)T2~T4時M組患者的MAP顯著降低(P0.05),且顯著低于D組(P0.05);T1~T4時,D組與M組病人的HR進行對比,差異沒有統(tǒng)計學意義(P0.05);與T0相比較,T2~T4時M組患者RR和SPO2均明顯下降(P均0.05),與D組比較,差異有統(tǒng)計學意義(P0.05);與T0相比較,T1~T4時2組患者OAA/S評分均顯著下降(P0.05),且T2~T4時M組明顯低于D組(P0.05);D組病人不良反應發(fā)生率與M組進行對比,D組明顯比M組少(P0.05);M組患者順行性遺忘率情況與D組進行對比,差異沒有統(tǒng)計學意義(P0.05)。結(jié)論:1.D組患者與M組進行對比,D組患者呼吸抑制作用相對較弱,血流動力學更加穩(wěn)定,不良反應的發(fā)生率比M組要少的多。2.右美托咪定能夠起到良好的鎮(zhèn)靜作用,患者在鎮(zhèn)靜狀態(tài)下喚醒也比較容易,對老年患者呼吸功能的影響也比較小,能夠降低寒戰(zhàn)的發(fā)生幾率,并且能夠明顯減少嗆咳、惡心、嘔吐、體動、抑制呼吸、氣道梗阻等不良反應的發(fā)生次數(shù),是一種比較理想的靜脈鎮(zhèn)靜藥。
[Abstract]:Aim: to compare the effects of dexmetidine and midazolam on circulation, sedation and respiratory inhibition in elderly patients under combined spinal-epidural anesthesia. To study the efficacy and safety of dexmetomidine in the treatment of combined spinal-epidural anesthesia in elderly patients. Methods: the first affiliated Hospital of Henan University of Science and Technology and the first affiliated Hospital of Nanyang Medical College from June 2015 to June 2016 were selected for lower abdomen. Eighty patients (45 males and 35 females) undergoing lower limb surgery with combined spinal-epidural anesthesia, with an average age of 72.42 鹵5.83 years old, were divided into two groups: control group and experimental group. Midazolam group (group M) and dexmetomidine group (group D, n = 40) were given midazolam (0.05 mg / kg) intravenously in 10 minutes after anaesthesia. Then the patients in group D were given dexmetomidine 0.5 渭 g / kg intravenously for 10 minutes at a velocity of 0.1 mg / kg / h. The mean arterial pressure (MAPV), heart rate (HRV), respiratory frequency (RRRR), improved alertness / sedation visual score (OAAS) and blood oxygen saturation (SPO _ 2) were observed and compared in the two groups before and 10 min after administration. The incidence of adverse reactions during operation and the degree of amnesia during 24 hours follow-up were recorded in detail. Results: compared with T0. It was found that the MAP of M group was significantly lower than that of group D (P 0.05), and significantly lower than that of group D (P 0.05), and the HR of group D and M was not significantly different from that of group M, and the RR and SPO2 of group M were significantly lower than those of group D (P < 0.05), and that of group D were significantly lower than that of group D (P < 0.05). Compared with T0, the OAA/S scores of both groups were significantly decreased, and the incidence of adverse reactions in group M was significantly lower than that in group D (P 0.05) and the incidence of adverse reactions in group D was significantly lower than that in group M (P 0.05) than that in group M (P 0.05), and the incidence of adverse reactions in group D was significantly lower than that in group M (P < 0.05), and the incidence of adverse reactions in group D was significantly lower than that in group D (P < 0.05), and the incidence of adverse reactions in group D was significantly lower than that in group M. The antegrade amnesia rate was compared with that in group D. Conclusion compared with M group, the respiratory inhibition effect of D group is relatively weak and the hemodynamics is more stable. The incidence of adverse reactions was much lower in group M than in group M. Dexmetomidine could play a good sedative effect, and it was easier for patients to wake up under sedation, and had little effect on respiratory function in elderly patients. It can reduce the incidence of shivering, and can obviously reduce the occurrence times of cough, nausea, vomiting, body movement, respiratory suppression, airway obstruction and other adverse reactions. It is an ideal drug for intravenous sedation.
【學位授予單位】：河南科技大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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