本文選題：右美托咪定 + 地佐辛��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:宮頸錐切手術(shù)是婦科常見的日間短小手術(shù)之一,其特點(diǎn)是手術(shù)時(shí)間短,刺激輕,對麻醉效果、麻醉起效時(shí)間以及蘇醒時(shí)間都有較高的要求。一般丙泊酚復(fù)合舒芬太尼就能完成,但術(shù)中麻醉深度不足,往往因體動(dòng)反應(yīng)影響手術(shù)醫(yī)生操作,麻醉過深易呈現(xiàn)出呼吸抑制、蘇醒延遲,術(shù)后易出現(xiàn)疼痛反應(yīng)、寒戰(zhàn)反應(yīng)、惡心嘔吐等不良反應(yīng)。右美托咪定(DEX,Dexmedetomidine)作為一種新型的高選擇性α2腎上腺素受體激動(dòng)劑,具有鎮(zhèn)靜、鎮(zhèn)痛、抑制交感神經(jīng)系統(tǒng)活性的作用,并且患者在術(shù)中易喚醒,其最大的特點(diǎn)是無呼吸抑制。地佐辛是一種強(qiáng)效阿片類混合受體激動(dòng)藥,激動(dòng)k受體,對μ受體有部分激動(dòng)部分拮抗的作用,可產(chǎn)生強(qiáng)效鎮(zhèn)痛和良好鎮(zhèn)靜的作用,不易產(chǎn)生耐受性,呼吸抑制較輕。本實(shí)驗(yàn)的目的在于研究對照靶控輸注丙泊酚復(fù)合右美托咪定與地佐辛進(jìn)行鎮(zhèn)痛鎮(zhèn)靜,用于宮頸錐切手術(shù)的臨床可行性、安全性和不良反應(yīng)的發(fā)生情況等。方法:選取我院60例擬靜脈麻醉(TIVA)下?lián)衿谛袑m頸錐切手術(shù)的患者作為研究對象,年齡在35~45歲之間,BMI18.5~24之間,ASAI~II級(jí),采用隨機(jī)數(shù)字表法分為A(對照組)、B(實(shí)驗(yàn)組)兩個(gè)組別。兩組分別與術(shù)前10分鐘靜脈輸注地佐辛0.1mg/kg和右美托咪定0.8μg/kg,隨后給予舒芬太尼0.1μg/kg,繼之啟動(dòng)靶控輸注丙泊酚,血漿靶濃度(Cp)起始設(shè)置為1.2μg/ml,當(dāng)與效應(yīng)室濃度平衡2min后,以0.1μg/ml的梯度逐漸調(diào)整,直至睫毛反射消失后,開始手術(shù)。術(shù)中維持BIS在50~60之間,根據(jù)患者反應(yīng)和腦電雙頻譜指數(shù)(BIS)的變化,調(diào)節(jié)丙泊酚靶控濃度,手術(shù)結(jié)束前5分鐘停止輸注丙泊酚。觀察并記錄(1)患者入室5min(基礎(chǔ)值)(T0)、手術(shù)開始(T1)、手術(shù)開始10min(T2)、手術(shù)結(jié)束(T3)及意識(shí)恢復(fù)(呼之睜眼)(T4)時(shí)的平均動(dòng)脈血壓(MAP)、心率(HR),脈搏血氧飽和度(Sp O2)、呼吸頻率(RR);(2)手術(shù)時(shí)間;丙泊酚平均效應(yīng)室濃度、丙泊酚總用量;蘇醒時(shí)間(停止丙泊酚輸注至呼之睜眼時(shí))及輔助用藥使用情況等;(3)自主睜眼后10min Ramsay評分及術(shù)后疼痛視覺模擬評分(VAS)和麻醉滿意度評分等;(4)術(shù)中及術(shù)后不良事件發(fā)生情況。結(jié)果:所有患者均能成功完成手術(shù),兩組患者的手術(shù)時(shí)間、VAS評分及麻醉滿意度評分均無明顯差異(P0.05)。B組丙泊酚平均效應(yīng)室濃度(1.68±0.23)、總用量(149.57±9.89)、蘇醒時(shí)間(4.20±0.71)、Ramsay評分(2.77±0.73)均小于A組(2.11±0.32),(168.47±8.21),(5.03±0.93)、(3.83±1.12)(P㩳0.05)。A組在T1、T2時(shí)刻MAP下降顯著(P㩳0.05),B組T1時(shí)HR較T0時(shí)下降顯著(P㩳0.05),其余各時(shí)間點(diǎn)差異均無統(tǒng)計(jì)學(xué)意義。B組Sp O2維持滿意,A組有4例患者出現(xiàn)呼吸抑制,兩組患者用藥以后呼吸次數(shù)均減慢。B組術(shù)后不良反應(yīng)發(fā)生率均小于A組(P㩳0.05)。結(jié)論:與地佐辛相比,右美托咪定應(yīng)用于宮頸錐切術(shù)能更有效的維持血流動(dòng)力學(xué)的穩(wěn)定,減少術(shù)后不良反應(yīng)的發(fā)生,但應(yīng)用時(shí)應(yīng)注意對心率的影響。
[Abstract]:Objective: cervical conization is one of the most common short day operations in gynecology, which is characterized by short operation time, light stimulation and high requirements for anesthetic effect, anaesthesia onset time and recovery time. General propofol combined with sufentanil can be completed, but the depth of anesthesia is insufficient during the operation, which often affects the operation of the surgeon because of the body movement reaction. The deep anesthesia is prone to respiratory inhibition, delayed recovery, postoperative pain response and shivering reaction. Adverse reactions such as nausea and vomiting. Dexmedetomidine (Dexmedetomidine), a new type of highly selective 偽 2-adrenergic receptor agonist, has the effects of sedation, analgesia and inhibition of sympathetic nervous system activity. Dizosin is a potent opioid mixed receptor stimulator, which excites k receptor, and has partial antagonistic effect on 渭 receptor, which can produce strong analgesia and good sedative effect, not easy to produce tolerance, and mild respiratory inhibition. The purpose of this study was to study the clinical feasibility, safety and adverse reactions of target controlled infusion of propofol combined with dextromidine and dizosin for analgesia and sedation. Methods: a total of 60 patients undergoing cervical conization under intravenous anesthesia in our hospital were selected as the study subjects. The patients aged between 35 and 45 years old were divided into two groups: group A (control group) and group A (control group) by random number table method. The patients aged between 35 and 45 years old were divided into two groups: ASAI 鈪，

本文編號(hào)：1990038