本文選題：右美托咪定 + 術(shù)后認知功能障礙��； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究通過觀察單肺通氣對老年食管癌患者根治術(shù)后認知功能障礙的影響,探討圍術(shù)期持續(xù)泵注右美托咪定對患者炎性因子和腦氧代謝率的變化以及是否改善患者術(shù)后認知功能障礙。方法:選擇西南醫(yī)科大學(xué)附屬中醫(yī)院麻醉科2014年1月-2014年9月期間擇期食管癌根治手術(shù)老年患者60例,年齡65~80歲,男女不限,ASA分級Ⅰ~Ⅱ級,隨機分為右美托咪定實驗組(D組,n=30)和生理鹽水對照組(C組,n=30)兩組。D組麻醉誘導(dǎo)前給予靜脈微泵輸注右美托咪定1μg/kg,輸注時間15min,術(shù)中維持用靜脈微泵輸注0.5μg·kg·h,于手術(shù)結(jié)束前15 min停用。C組在同一時間點給予等量的生理鹽水。兩組患者常規(guī)給予芬太尼、丙泊酚、順式阿曲庫銨順序麻醉誘導(dǎo),在腦電雙頻指數(shù)下降至40時進行雙腔支氣管插管,插管成功后接麻醉機控制通氣,模式為容量控制模式。術(shù)中靜脈持續(xù)泵注丙泊酚、瑞芬太尼、阿曲庫銨,1~2%七氟烷吸入維持適宜的麻醉深度(腦電雙頻指數(shù)在40~60之間)。術(shù)中單肺通氣時間控制在2~3h,血氧飽和度95%以上。手術(shù)結(jié)束前15min停用吸入麻醉藥和肌松藥,接入鎮(zhèn)痛泵并同時給予負荷劑量。術(shù)后鎮(zhèn)痛采用100ml一次性使用自控電子輸注泵,使用時間48小時。配方:D組右美托咪定0.08μg·kg·h+舒芬太尼0.04μg·kg·h+托烷司瓊10 mg;C組舒芬太尼0.04μg·kg·h+托烷司瓊10 mg。鎮(zhèn)痛泵負荷劑量6 ml,背景輸注速率2 ml/h,自控按壓劑量2 ml,鎖定時間15 min。實驗觀察指標:分別于手術(shù)前1天(T_0),術(shù)后第1天(T_1),術(shù)后第3天(T_2),術(shù)后第7天(T_3)測定簡易精神狀態(tài)量表(MMSE)評分、疼痛VAS評分和鎮(zhèn)靜Ramsay評分,同時于誘導(dǎo)前(T_a)、術(shù)后拔管即刻(T_b)、術(shù)后24h(T_c)、術(shù)后72h(T_d)抽取靜脈血行血清IL-6和S-100β蛋白測定,并抽取頸靜脈血和動脈血行血氣分析,根據(jù)Fick公式計算動-靜脈血氧含量差(Da-jv O2)和腦氧攝取率(CMRO_2)。結(jié)果:(1)與C組比較,D組T_1、T_2時MMSE評分明顯升高(P0.05),而POCD發(fā)生率明顯降低(P0.05);(2)與C組比較,D組T_b和T_c時IL-6、S-100β蛋白明顯降低(P0.05);(3)與C組比較,D組T_b和T_c時動-靜脈血氧含量差和腦氧代謝率明顯降低(P0.05);(4)與C組比較,D組T1時鎮(zhèn)靜Ramsay評分明顯升高(P0.05),D組T_1、T_2時疼痛VAS評分明顯降低(P0.05),兩組均未有呼吸抑制的出現(xiàn)。結(jié)論:(1)本研究劑量的右美托咪定可以協(xié)同鎮(zhèn)靜鎮(zhèn)痛作用,鎮(zhèn)靜深度適宜,無呼吸抑制作用;(2)應(yīng)用右美托咪定可以降低IL-6、S-100β蛋白和腦氧代謝率,降低POCD的發(fā)生率。
[Abstract]:Objective: to observe the effect of single lung ventilation on cognitive dysfunction in elderly patients with esophageal cancer after radical operation. Objective: to investigate the changes of inflammatory factors and cerebral oxygen metabolism rate in patients with dexmetomidine during perioperative period and whether to improve the cognitive dysfunction after operation. Methods: sixty elderly patients aged 65 to 80 were selected from Department of Anesthesiology, Department of Anesthesiology, affiliated Hospital of Southwest Medical University from January 2014 to September 2014. Two groups were randomly divided into two groups: dexmetomidine group (group D) and saline control group (group C). Group D was given intravenous micropump infusion of dexmetomidine 1 渭 g / kg before anesthesia induction for 15 minutes. Intraoperative maintenance of intravenous micropump infusion of 0. 5 渭 g kg h, was given to the operative knot before anesthesia induction. Group C. was given the same amount of saline at the same time point 15 min before the beam. The patients in both groups were induced by sequential anesthesia of fentanyl propofol and cis atracurium. The patients were intubated with double-lumen bronchial intubation when the bispectral index of EEG decreased to 40. After successful intubation the ventilation was controlled by anaesthesia machine and the mode was volume control mode. Intravenous infusion of propofol, remifentanil and atracurium 1 ~ 2% sevoflurane maintained an appropriate anesthetic depth (EEG bispectral index was between 40 and 60). The duration of single lung ventilation was controlled at 2 h for 3 h, and the oxygen saturation was over 95%. At the end of the operation, 15min stopped inhaling anesthetics and muscle relaxants, injected analgesic pump and given loading dose at the same time. Postoperative analgesia was performed by 100ml with a self-controlled electronic infusion pump for 48 hours. Sufentanitanil 0.08 渭 g kg h sufentanil 0.04 渭 g kg h tropisetron 10 mg / g, sufentanil 0.04 渭 g kg h tropisetron 10 mg / g. The analgesic pump loading dose was 6 ml, the background infusion rate was 2 ml / h, the self-controlled compression dose was 2 ml, and the locking time was 15 min. The experimental outcome measures: 1 day before operation, 1 day after operation, 3 days after operation, 7 days after operation. The scores of mini-mental state scale (MMSE), pain VAS score and sedative Ramsay score were measured. At the same time, before induction, immediately after the extubation of Tastasia, immediately after the extubation of TCI, 24 hours after operation, 24 hours after operation, 72 hours after operation, venous blood was taken for determination of serum IL-6 and S-100 尾 protein, and jugular vein blood and arterial blood were taken for blood gas analysis. According to the Fick formula, the difference of arterial and venous oxygen content (Da-jv O _ 2) and cerebral oxygen uptake rate were calculated. Results compared with group C, the MMSE score of group D was significantly higher than that of group C, and the incidence of POCD was significantly lower than that of group C. (compared with group C, the expression of IL-6 protein S-100 尾 in group D was significantly lower than that in group C, and the difference in blood oxygen content between group D and group C was significantly lower than that in group C and group C in T _ b and T _ c, respectively. Compared with group C, the sedative Ramsay score of group D was significantly higher than that of group C at T _ 1 and T _ 2. The VAS score of pain in group T _ (1) and T _ (2) was significantly lower than that in group C, and there was no respiratory inhibition in both groups. Conclusion: the dose of dexmetomidine in this study can cooperate with sedative analgesia, the depth of sedation is suitable, and there is no effect of respiratory inhibition. Dexmetomidine can reduce the level of IL-6 S-100 尾 protein and cerebral oxygen metabolism, and reduce the incidence of POCD.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614;R735.1

【參考文獻】

相關(guān)期刊論文 前10條

1 陳思涵;Yee Wei LIM;聞大翔;俞衛(wèi)鋒;;術(shù)前慢性疼痛對大鼠術(shù)后認知功能下降的易化作用和對中縫背核區(qū)色氨酸羥化酶的影響[J];上海醫(yī)學(xué);2016年06期

2 楊歡;鄭小蘭;徐國海;陳勇;羅振中;;電針刺激對糖尿病患者術(shù)后認知功能及血清炎性因子的影響[J];臨床麻醉學(xué)雜志;2015年11期

3 張錦華;仲吉英;楊承祥;;右美托咪定對老年食管癌術(shù)中單肺通氣患者手術(shù)后早期認知功能障礙的影響[J];廣東醫(yī)學(xué);2015年11期

4 丁進峰;陳玲陽;曹海華;;右美托咪定聯(lián)合舒芬太尼對胸腔鏡下食道癌根治術(shù)后自控鎮(zhèn)痛的效果[J];中國內(nèi)鏡雜志;2015年05期

5 高鵬;古妙寧;蔡鐵良;沈七襄;張正迪;施瓊;;右美托咪定對全麻下腦語言功能區(qū)手術(shù)術(shù)中喚醒的影響[J];臨床麻醉學(xué)雜志;2015年01期

6 關(guān)正;張永健;景桂霞;袁偉;劉t熃，

本文編號：1851196