本文選題：氟馬西尼　切入點(diǎn)：丙泊酚　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過觀察氟馬西尼對(duì)丙泊酚復(fù)合舒芬太尼全身麻醉患者恢復(fù)期血漿中orexin-A濃度水平的影響,來探討orexin-A是否與氟馬西尼的促進(jìn)麻醉蘇醒作用相關(guān)。方法選擇需要全憑靜脈全身麻醉行擇期腹腔鏡下全子宮切除術(shù)或者子宮肌瘤剝除術(shù)的患者,共40例,ASA為I~II級(jí),隨機(jī)分為實(shí)驗(yàn)組(氟馬西尼組)和對(duì)照組(生理鹽水組),每組各20例。患者入室后建立上肢靜脈通路,給予常規(guī)補(bǔ)液,并行橈動(dòng)脈穿刺置管術(shù),連續(xù)監(jiān)測(cè)袖帶血壓(NBP)、動(dòng)脈血壓(ABP)、心率(HR)、心電圖(ECG)、血氧飽和度(Sp O2)、腦電雙頻指數(shù)值(BIS)。麻醉誘導(dǎo)時(shí)依次靜脈注射丙泊酚1~1.5mg/kg,舒芬太尼0.32~0.5μg/kg以及順苯磺酸阿曲庫銨0.3mg/kg,3分鐘后行氣管插管術(shù),連接麻醉機(jī)行機(jī)控呼吸。術(shù)中丙泊酚以4~10mg·kg-1·h-1持續(xù)泵注,使BIS值控制在50~60,根據(jù)手術(shù)情況,間斷追加順苯磺酸阿曲庫銨以及舒芬太尼。距離手術(shù)結(jié)束約30分鐘時(shí),停止追加順苯磺酸阿曲庫銨及舒芬太尼,丙泊酚在關(guān)腹后停止泵注。關(guān)腹后實(shí)驗(yàn)組按0.007mg/kg靜脈注射氟馬西尼,對(duì)照組亦在關(guān)腹后給予同等劑量的生理鹽水。在給藥(氟馬西尼或生理鹽水)前(T0)、給藥后5min(T1)、給藥后15min(T2)、給藥后30min(T3)四個(gè)時(shí)間點(diǎn),分別抽取橈動(dòng)脈血3.0ml,離心后采用ELISA檢測(cè)血漿中orexin-A濃度。記錄患者呼喚時(shí)睜眼時(shí)間、拔出氣管插管時(shí)間以及術(shù)后并發(fā)癥發(fā)生率。結(jié)果氟馬西尼組(F組)與生理鹽水組(N組)比較,給藥后患者BIS值升高迅速,并且患者睜眼時(shí)間及拔出氣管插管時(shí)間均縮短,P0.05;兩組患者T1、T2、T3的orexin-A濃度比T0的orexin-A濃度高,P0.05,且F組在T1、T2、T3三個(gè)時(shí)間點(diǎn)的orexin-A濃度均較N組高,P0.05;術(shù)后F組與N組比較,兩組患者發(fā)生煩躁、寒戰(zhàn)、惡心等并發(fā)癥的差別沒有統(tǒng)計(jì)學(xué)意義,p0.05。結(jié)論氟馬西尼可產(chǎn)生促醒作用,使手術(shù)患者的麻醉恢復(fù)時(shí)間縮短;在麻醉恢復(fù)期,氟馬西尼可提高復(fù)合使用丙泊酚和舒芬太尼進(jìn)行全身麻醉的患者血漿中的orexin-A濃度,這有可能是氟馬西尼產(chǎn)生促醒作用的機(jī)制之一。
[Abstract]:Objective to observe the effect of flumazenil on plasma orexin-A concentration in patients with general anesthesia of propofol and sufentanil. To investigate whether orexin-A is related to the effect of flumacini on anaesthesia recovery. Methods A total of 40 patients were selected for elective laparoscopic hysterectomy or hysteromyomectomy with total intravenous general anesthesia. The patients were randomly divided into experimental group (flumacini group) and control group (normal saline group, 20 cases in each group). Continuous monitoring of cuff blood pressure (NBPU), arterial blood pressure (ABP), heart rate (HRG), electrocardiogram (ECG) ECGG, blood oxygen saturation (SPO _ 2), bispectral index (BISS). Propofol (11.5 mg / kg), sufentanil (0.320.5 渭 g / kg) and ammonium sulfosulfonate (0.3 mg / kg) were injected intravenously during anesthesia induction, and endotracheal intubation was performed 3 minutes later. During the operation, propofol was continuously pumped with 4U 10 mg 路kg-1 路h -1 to control the BIS value at 50 擄60. According to the operation conditions, the sufentanil and atracurium benzenesulfonate were added intermittently. About 30 minutes from the end of the operation, The injection of propofol was stopped after the abdominal closure. The experimental group was injected with flumazenil at 0.007 mg / kg intravenously after abdominal closure. The control group was also given the same dose of normal saline after abdominal closure. There were four time points before administration (flumacini or normal saline), 5 min after administration, 15 min after administration, 15 min after administration, 30 min after administration and 30 min after administration. Radial artery blood was drawn from 3.0 ml, and the plasma orexin-A concentration was measured by ELISA after centrifugation. The time of eye opening, tracheal intubation and postoperative complications were recorded. Results the results were compared with those of normal saline group (n group) and flumazenil group (F group). The BIS value of the patients increased rapidly after administration. The time of eye opening and tracheal intubation was shortened by P0.05.The orexin-A concentration of T1T _ 2T _ 3 in two groups was higher than that of orexin-A of T _ 0, and the orexin-A concentration of group F was higher than that of group N at three time points of T _ 1 and T _ 2T _ 3.Compared with that of group N, the patients in group F had agitation. There was no significant difference in complications such as shivering, nausea and other complications (p 0.05). Conclusion flumacini can promote the recovery of anesthesia and shorten the recovery time of the patients. Flumazenil can increase the concentration of orexin-A in the plasma of patients under general anesthesia with propofol and sufentanil, which may be one of the mechanisms of the arousal effect of flumazenil.
【學(xué)位授予單位】：青島大學(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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