本文選題：右美托咪定 + 肺功能��； 參考：《青島大學》2017年碩士論文

【摘要】：目的:探討在全身麻醉的狀態(tài)下,經(jīng)靜脈給予右美托咪定對老年脊柱后入路手術(shù)患者肺功能的影響。方法:選擇擇期在青島大學附屬醫(yī)院嶗山院區(qū)行脊柱后入路手術(shù)符合實驗條件的老年患者60例為實驗研究對象,按照隨機數(shù)表法將研究對象分為對照組(C組)以及試驗組(D組),每組老年患者為30例。在全身麻醉誘導插管之后,D組經(jīng)靜脈給予右美托咪定0.05μg/(kg·min)劑量持續(xù)泵入,10min后以0.5μg/(kg·h)劑量進行持續(xù)泵入維持。C組經(jīng)靜脈持續(xù)泵入等量生理鹽水作為對比。氣管插管后取患者平臥位5min(T0)、俯臥位后5min(T1)、俯臥位后1h(T2)、俯臥位后2h(T3),并且監(jiān)測記錄患者各個時刻呼氣末二氧化碳分壓(PETCO_2)、氣道峰壓(Ppeak)、動態(tài)肺順應(yīng)性(Cdyn)、靜態(tài)肺順應(yīng)性(Cstat)、潮氣量(VT)等數(shù)值�；颊呷胧液笤诰致橄滦袠飫用}穿刺,分別在T0、T1、T2、T3時刻經(jīng)橈動脈抽取患者動脈血進行血氣分析,并且記錄各個時刻患者血氣值中二氧化碳分壓(PaCO_2)以及動脈血氧分壓(PaO_2),通過公式計算出肺泡-動脈血氧分壓差(PA-aDO2)、呼吸指數(shù)(RI)以及氧合指數(shù)(OI)。將所有數(shù)據(jù)進行采用SPSS 21.0統(tǒng)計軟件處理,研究經(jīng)靜脈給予右美托咪定對老年脊柱后入路手術(shù)患者肺功能各項指標的影響。結(jié)果:組間對比,兩組患者在年齡、性別、身體質(zhì)量指數(shù)(BMI)基礎(chǔ)資料方面對比無統(tǒng)計學差異。將實驗患者由平臥位調(diào)整成為俯臥位后,呼吸力學指標比較,組內(nèi)對比,在T0與T1、T2、T3時刻對比,T1、T2、T3時刻Cdyn、Cstat指標較低有統(tǒng)計學意義(P0.05),Ppeak指標有所升高有統(tǒng)計學意義(P0.05)。組間對比,在T3時刻C組Cdyn、Cstat指標比D組都有所降低有統(tǒng)計學意義(P0.05),Ppeak指標C組比D組增加更為明顯有統(tǒng)計學意義(P0.05)。血氣指標比較,組內(nèi)對比,在T0與T2、T3時刻對比,T2、T3時刻OI指標較低有統(tǒng)計學意義(P0.05),PA-aO2、RI指標較高有統(tǒng)計學意義(P0.05)。組間對比,在T3時刻C組與D組對比,C組OI指標比D組都有所降低有統(tǒng)計學意義(P0.05),而P_(A-a)O_2、RI此項指標C組比D組增加更為明顯有統(tǒng)計學意義(P0.05)。在整個手術(shù)階段組間對比,兩組患者在手術(shù)過程中VT、PETCO_2、手術(shù)時間、出血量對比無統(tǒng)計學差異。結(jié)論:通過組間對比結(jié)果顯示,在全身麻醉狀態(tài)下進行脊柱后入路手術(shù)的老年患者中,術(shù)中通過靜脈給予右美托咪定可以明顯改善老年患者肺功能,對肺功能起到保護性的作用。通過組內(nèi)對比結(jié)果顯示長時間的俯臥位脊柱手術(shù),應(yīng)注意對患者肺功能的保護,加強監(jiān)測患者圍術(shù)期肺功能各項指標,防止術(shù)后肺部并發(fā)癥的發(fā)生。
[Abstract]:Objective: to investigate the effects of intravenous dexmetomidine on pulmonary function in elderly patients undergoing posterior spinal approach under general anesthesia. Methods: sixty elderly patients who underwent spinal posterior approach in Laoshan Hospital affiliated to Qingdao University were selected as experimental subjects. According to the random number method, the subjects were divided into control group C (n = 30) and group D (n = 30). After induction and intubation of general anesthesia, group D received dexmetomidine (0. 05 渭 g/(kg / min) continuously for 10 minutes and then sustained pump (0. 5 渭 g/(kg / h). Group C was continuously pumped into the same amount of normal saline through vein as a comparison. After endotracheal intubation, the patients were taken from the supine position for 5 min, the prone position for 5 min, the supine position for 1 h, and the supine position for 2 h, and the values of PETCO _ 2, peak airway pressure, dynamic lung compliance, static lung compliance, tidal volume and VT were monitored and recorded. After entering the room, the patients underwent radial artery puncture under local anesthesia. The arterial blood was extracted from the patients by the radial artery at the time of T0 T 1 and T 2 T 3 for blood gas analysis. Paco _ 2) and Pao _ 2s were recorded at each time. The alveolar-arterial oxygen pressure difference (PA-aDO2), respiratory index (RI) and oxygenation index (Oi) were calculated by formula. All the data were processed by SPSS21.0 statistical software to study the effects of intravenous dexmetomidine on pulmonary function in elderly patients undergoing posterior spinal approach. Results: there was no significant difference in basic data of age, sex and BMI between the two groups. After the patients were adjusted from supine position to prone position, the indexes of respiratory mechanics and intragroup comparison were compared, and the Cdynntam Cstat index was significantly lower at T0 and T1T2T2T 3 time than that at T1 T 2 + T 2 + T 3 time. There was a significant increase in P0.05 and Ppeak index (P 0.05). Compared with group D at T3, the Cdynnnnncstat index in group C was significantly lower than that in group D. There was significant difference between group C and group D in the increase of Cdynng and Cstat in group C (P 0.05) compared with that in group D (P 0.05). Compared with T0 and T2T 3, the OI of T 2 T 3 was lower than that of P 0 05 P 0 05 and PA-aO 2 O 2 RI was higher than that of T 2 O 2 T 3. There was a significant difference in P 0 05 between T 0 and T 2 T 3 and T 2 O 2 T 3 compared with T 0 and T 2 T 3. Compared with group D, the OI index of group C was significantly lower than that of group D at T3 time, while the index of P _ (A) A _ (A) O _ (2) RI in group C was significantly higher than that of group D (P _ (0.05) ~ 0. 05%), while that of group C was significantly lower than that of group D (P < 0. 05%), and that of group C was significantly higher than that of group D (P < 0. 05). There was no significant difference in the time of operation and the amount of blood loss between the two groups during the operation. Conclusion: the results of comparison between groups showed that intravenous dexmetomidine could significantly improve pulmonary function in elderly patients undergoing spinal posterior approach under general anesthesia. It has protective effect on lung function. According to the results of intra-group comparison, we should pay attention to the protection of pulmonary function, strengthen the monitoring of the indexes of pulmonary function in perioperative period, and prevent the occurrence of postoperative pulmonary complications.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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