本文選題：右美托咪定 + 丙泊酚��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：研究目的:比較右美托咪定與丙泊酚在應(yīng)用蛛網(wǎng)膜下腔阻滯麻醉行下腹部手術(shù)中患者鎮(zhèn)靜效果。研究方法:將ASA分級為Ⅰ級或Ⅱ級在蛛網(wǎng)膜下腔阻滯下行下腹部手術(shù)患者80例隨機(jī)分為2組,應(yīng)用右美托咪定輔助鎮(zhèn)靜的D組和丙泊酚輔助鎮(zhèn)靜的P組各40例,D組在麻醉平面固定后以1ug·kg-1·h-1的初始速度泵注10min,然后以0.5ug·kg-1·h-1的速度維持;P組在麻醉平面固定后以6mg·kg-1·h-1的初始速度泵注10min,然后以2.5mg·kg-1·h-1的速度維持。所有患者均采用標(biāo)準(zhǔn)化方案,不使用術(shù)前用藥,患者術(shù)中有任何疼痛或不適均需與麻醉醫(yī)生溝通。記錄患者術(shù)前人口統(tǒng)計(jì)學(xué)資料和術(shù)后恢復(fù)情況,應(yīng)用OAA/S鎮(zhèn)靜評分對兩組患者進(jìn)行觀察,記錄兩組患者在輸注藥物即刻及之后每間隔5min的HR、MAP、OAA/S鎮(zhèn)靜評分至手術(shù)結(jié)束,并記錄兩組患者術(shù)中牽拉反應(yīng)以及不良反應(yīng)的發(fā)生情況。研究結(jié)果:1.兩組患者術(shù)前人口統(tǒng)計(jì)學(xué)資料無明顯差異,但術(shù)后恢復(fù)情況中有效鎮(zhèn)痛時(shí)間D組(179.50±8.93 min)顯著高于P組(151.30±8.29 min)(P0.05);D組停藥到OAA/S評分恢復(fù)到4分及以上的時(shí)間(19.40±2.48 min)明顯長于P組(13.93±1.99 min)(P0.05)。2.D組與P組兩組患者OAA/S鎮(zhèn)靜評分基礎(chǔ)值差異無統(tǒng)計(jì)學(xué)意義(P0.05)。泵注藥物后D組與P組均能達(dá)到適度鎮(zhèn)靜,但D組患者達(dá)到目標(biāo)鎮(zhèn)靜深度所需時(shí)間較P組長,D組在術(shù)中維持的鎮(zhèn)靜深度較P組深,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.D組與P組兩組患者心率與平均動(dòng)脈壓的基礎(chǔ)值差異無統(tǒng)計(jì)學(xué)意義(P0.05);泵注藥物后D組心率較P組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),P組平均動(dòng)脈壓較D組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.兩組患者均未出現(xiàn)嚴(yán)重的牽拉反應(yīng),抑制牽拉反應(yīng)的效果顯著。D組抑制牽拉反應(yīng)效果為優(yōu)的比例顯著高于P組,P組抑制牽拉反應(yīng)效果為良的比例顯著高于D組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5.兩組患者惡心嘔吐、心動(dòng)過緩、低血壓、寒戰(zhàn)不良反應(yīng)的發(fā)生率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。P組呼吸抑制的發(fā)生率顯著高于D組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:右美托咪定用于蛛網(wǎng)膜下腔阻滯麻醉行下腹部手術(shù)中的鎮(zhèn)靜效果優(yōu)于丙泊酚,循環(huán)及呼吸抑制作用輕微。右美托咪定與丙泊酚相比能夠有效的抑制牽拉反應(yīng),顯著延長蛛網(wǎng)膜下腔阻滯的時(shí)間。
[Abstract]:Objective: To compare dexmedetomidine anesthesia sedation effect for lower abdominal surgery with application of propofol in subarachnoid anesthesia. Methods: ASA grade was grade I or II in subarachnoid anesthesia in abdominal surgery under 80 cases of patients were randomly divided into 2 groups, D group and propofol sedation application right dexmedetomidine sedation in the P group with 40 cases in each group, D group in the level of anesthesia after fixation with 10min initial speed of infusion 1ug - kg-1 - H-1, and 0.5ug kg-1 to maintain the speed of H-1; P in group 10min after anesthesia fixed initial infusion speed 6mg - kg-1 - H-1. Then in order to maintain 2.5mg kg-1 H-1 speed. All the patients were treated with the standard scheme, without the use of preoperative medication, patients who have any pain or discomfort are required to communicate with the anesthesiologist. Record the preoperative demographics and postoperative recovery, OAA/S sedation assessment Divided into two groups of patients were observed in two groups were recorded every 5min in the infusion of the drug immediately and after each HR, MAP, OAA/S sedation score to the end of surgery, and recorded the stretch reaction and the adverse reaction of the patients in the two groups. Results: no significant difference between the 1. groups of patients in the previous two statistical data, but the postoperative recovery in effective analgesia time D group (179.50 + 8.93 min) was significantly higher than that of group P (151.30 + 8.29 min) (P0.05); D group to return to the discontinuation of OAA/S score 4 points and over time (19.40 + 2.48 min) was longer than that of group P (13.93 + 1.99 min) (P0.05).2.D group and P group, two groups of patients with OAA/S sedation score based value difference (P0.05). After drug infusion of D group and P group could achieve moderate sedation, but D patients reached the target sedation time is P group, D group to maintain the depth of sedation during operation compared with P group, the difference was statistically Statistically significant (P0.05) of.3.D group and P group of two groups of patients with heart rate and mean arterial blood pressure was no significant difference (P0.05); group D after drug infusion rate was lower than that of P group, the difference was statistically significant (P0.05), mean arterial pressure in P group was lower than that of D group, the difference was statistically significant (P0.05).4. two group of patients without severe stretch reaction, the effect of inhibition of traction reaction in.D group significantly inhibition of traction reaction results were excellent ratio was significantly higher than P group, P group, inhibition of traction reaction effect is good the proportion was significantly higher than D group, the difference was statistically significant (P0.05.5. two) group of patients with nausea and vomiting, bradycardia, hypotension, adverse reaction incidence of shivering was no statistically significant difference (P0.05) the incidence of respiratory depression in group.P was significantly higher than that of D group, the difference was statistically significant (P0.05). Conclusion: dexmedetomidine for subarachnoid block anesthesia for abdominal surgery in the town The static effect is superior to propofol, and the inhibition of circulation and respiration is slight. Dexmedetomidine can effectively inhibit the traction reaction and prolong the time of subarachnoid block compared with propofol.

【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】：2017
【分類號】：R614

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