發(fā)布時(shí)間：2018-06-29 22:05

  本文選題：右美托咪定(DEX) + 預(yù)先給藥　； 參考：《蘇州大學(xué)》2015年碩士論文

【摘要】：目的比較右美托咪定預(yù)先給藥對青年和老年病人全身麻醉期間丙泊酚用量、麻醉誘導(dǎo)和蘇醒時(shí)間、血流動力學(xué)及不良反應(yīng)的影響。方法擇期全麻下行甲狀腺切除術(shù)青年患者(20~39歲)40例,老年患者(66~80歲)40例,ASAⅠ~Ⅱ級。依據(jù)預(yù)先給藥(右美托咪定或生理鹽水)不同,隨機(jī)分為青年右美組,青年對照組,老年右美組,老年對照組,每組各20例。于全麻誘導(dǎo)前10min,青年右美組和老年右美組泵注0.5ug/kg右美托咪定,青年對照組和老年對照組泵注等量生理鹽水。四組患者采用相同麻醉方法,術(shù)中根據(jù)腦電雙頻指數(shù)值(BIS)調(diào)節(jié)丙泊酚血漿靶控濃度,維持BIS值在45±5。記錄入室(T0)、誘導(dǎo)前(T1)、誘導(dǎo)后(T2)、插管時(shí)(T3)、切皮時(shí)(T4)、切皮后30min(T5)、術(shù)畢(T6)、拔管時(shí)(T7)的心率(HR)、收縮壓(SBP)、舒張壓(DBP);記錄T2~T6各時(shí)點(diǎn)丙泊酚血漿靶控濃度(Cp);記錄丙泊酚誘導(dǎo)用量、丙泊酚總量、麻醉誘導(dǎo)時(shí)間及蘇醒時(shí)間;記錄術(shù)后24h的疼痛評分、鎮(zhèn)靜評分及惡心嘔吐評分。結(jié)果1.血漿靶控濃度:相同年齡段組內(nèi)比較,青年對照組明顯高于青年右美組,老年對照組明顯高于老年右美組(P0.05);不同年齡段組間比較,老年右美組明顯低于青年右美組(P0.05),老年右美組、老年對照組明顯低于青年對照組(P0.05);2.丙泊酚用量:相同年齡段組內(nèi)比較,青年對照組丙泊酚誘導(dǎo)量與總量均明顯大于青年右美組,老年對照組丙泊酚誘導(dǎo)量與總量均明顯大于老年右美組(P0.05);不同年齡段組間比較,老年右美組丙泊酚誘導(dǎo)量與總量均明顯小于青年右美組,老年對照組的丙泊酚誘導(dǎo)量明顯大于青年右美組,總量明顯小于青年右美組(P0.05);老年右美組、老年對照組丙泊酚誘導(dǎo)量與總量均明顯小于青年對照組(P0.05);3.血流動力學(xué):青年對照組、老年對照組的HR、SBP、DBP在插管時(shí)(T3)、切皮時(shí)(T4),拔管時(shí)(T7)與誘導(dǎo)后(T2)相比均明顯升高(P0.05);青年右美組的HR、SBP、DBP在拔管時(shí)(T7)與誘導(dǎo)后(T2)相比明顯升高(P0.05)4.誘導(dǎo)時(shí)間:相同年齡段組內(nèi)比較,青年對照組誘導(dǎo)時(shí)間明顯長于青年右美組(P0.05),老年對照組誘導(dǎo)時(shí)間明顯長于老年右美組(P0.05);不同年齡段組間比較,老年對照組誘導(dǎo)時(shí)間明顯長于青年右美組(P0.05),老年右美組明顯短于青年右美組(P0.05);老年右美組和老年對照組誘導(dǎo)時(shí)間均明顯短于青年對照組(P0.05);其中老年右美組誘導(dǎo)時(shí)間最短,青年對照組誘導(dǎo)時(shí)間最長。5.蘇醒時(shí)間:老年組蘇醒時(shí)間明顯長于青年組(P0.05)。6.術(shù)后24h VAS評分、Ramesay評分及惡心、嘔吐評分:四組患者未出現(xiàn)明顯差異,無統(tǒng)計(jì)學(xué)意義(P0.05)。7.不良反應(yīng):未出現(xiàn)嚴(yán)重心動過緩、低血壓、寒戰(zhàn)、術(shù)后譫妄及術(shù)中知曉。結(jié)論1.相同劑量右美托咪定對不同年齡患者其量效不同,老年患者使用右美托咪定比青年患者更能節(jié)約丙泊酚的用量。2.右美托咪定預(yù)先給藥可使全麻患者血流動力學(xué)相對平穩(wěn),老年患者更為顯著。3.右美托咪定預(yù)先給藥可明顯縮短全麻誘導(dǎo)時(shí)間,老年患者更為顯著。
[Abstract]:Objective to compare the effects of propofol dosage, anesthesia induction and awakening time, hemodynamics and adverse reactions during general anesthesia in young and elderly patients. Methods 40 young patients (20~39 years old), 40 elderly patients (66~80 years old), ASA I ~ II. Metomomidin or saline) were divided randomly into young right beauty group, young control group, elderly right beauty group, aged control group, 20 cases in each group. Before induction of general anesthesia, 10min, young right beauty group and old right American group pump 0.5ug/kg right metoimidin, young control group and elderly control group. The four groups were treated with the same anesthesia. During the operation, the target control concentration of propofol was adjusted according to the bispectral index (BIS) value (BIS), and the BIS value was recorded in the chamber (T0), before induction (T1), after induction (T2), in intubation (T3), in the peel (T4), 30min (T5) after the incision, after the operation (T6), and in the extubation (HR), systolic pressure and diastolic pressure. Target control concentration (Cp); record propofol induction dosage, total propofol total, anesthesia induction time and awakening time; record the pain score of 24h, sedation score and nausea and vomiting score after operation. Results 1. plasma target control concentration: compared with the same age group, the young control group was significantly higher than the young right group, the elderly control group was significantly higher than the elderly right beauty. Group (P0.05); the comparison between different age groups, the elderly right beauty group was significantly lower than the young right group (P0.05), the elderly right beauty group, the elderly control group was significantly lower than the young control group (P0.05); 2. propofol dosage: the same age group, the young control group of propofol induced and the total amount were significantly greater than the young right group, the elderly control group propofol. The induction quantity and total amount were significantly greater than that of the elderly right group (P0.05). The propofol induction volume and total amount of the elderly right beauty group were significantly smaller than that of the young right group. The propofol induction in the elderly control group was significantly greater than that in the young right group, the total amount was significantly smaller than that in the young right group (P0.05), the elderly right beauty group and the elderly control group propos The phenol induction and total amount were significantly lower than that of the young control group (P0.05); 3. hemodynamics: the young control group, the HR, SBP, DBP in the aged control group (T3), the skin cutting (T4), the extubation (T7) and the induction (T2) significantly increased (P0.05); the HR, SBP, and DBP in the right group were significantly higher than the inducement (T2) 4.. Induction time: in the same age group, the induction time in the young control group was significantly longer than that in the young right group (P0.05), and the induction time of the elderly control group was significantly longer than that of the elderly right group (P0.05), and the induction time of the elderly control group was significantly longer than that of the right beauty group of Yu Qing years (P0.05), and the elderly right group was significantly shorter than the young right group (P 0.05): the induction time of the elderly right group and the elderly control group was significantly shorter than that of the young control group (P0.05). The induction time of the elderly right group was the shortest and the longest.5. awakening time in the young control group: the awakening time of the elderly group was longer than that of the young group (P0.05).6. after the 24h VAS score, the Ramesay score and nausea and vomiting score: the four groups of patients. There was no significant difference, no statistically significant (P0.05).7. adverse reactions: no severe bradycardia, hypotension, chills, postoperative delirium, and intraoperative awareness. Conclusion 1. the same dose of dexmedetomidin has different dose effects on patients of different ages. Right metomomidin can save propofol more than young patients for.2. right metoprolol. Pre administration of imidine can make the hemodynamics of the patients with general anesthesia relatively stable, and the elderly patients with.3. right metomomidine can significantly shorten the induction time of general anesthesia, and the elderly patients are more significant.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R614

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