不同BIS值對老年胃腸手術(shù)患者應(yīng)激反應(yīng)及血流動力學(xué)的影響
發(fā)布時間：2018-08-04 09:31
【摘要】：目的通過對擇期行胃腸道手術(shù)的老年患者在不同BIS值下的應(yīng)激指標(biāo)及血流動力學(xué)參數(shù)進行分析,探討B(tài)IS監(jiān)測下不同麻醉深度對老年胃腸道手術(shù)患者應(yīng)激反應(yīng)及血流動力學(xué)的影響,為臨床調(diào)控適宜麻醉深度,有效降低應(yīng)激提供理論依據(jù)。方法1選取華北理工大學(xué)附屬醫(yī)院2015年11月至2016年10月在靜吸復(fù)合麻醉下行胃腸道手術(shù)的老年患者(65~85歲)60例,美國麻醉醫(yī)師協(xié)會(ASA)分級Ⅰ~Ⅲ級,患者分為2組(按隨機數(shù)字表法,n=30):L組(BIS值維持50~59),D組(BIS值維持40~49)。術(shù)中按晶膠比為2:1補液使每搏變異度(SVV)維持在10±2。2抽取患者非輸液通路鎖骨下靜脈血,檢測患者血清皮質(zhì)醇(Cor)、促腎上腺皮質(zhì)激素(ACT_H)、血糖(Glu)水平于麻醉誘導(dǎo)前(T_0)、手術(shù)開始后120min(T_4)和拔管后60min(T_6)。3記錄兩組患者麻醉誘導(dǎo)前(T_0)、氣管插管后(T_1)、手術(shù)開始(T_2)、手術(shù)開始后60min(T_3)、手術(shù)開始后120min(T_4)、手術(shù)結(jié)束(T_5)、拔管后60min(T_6)的HR、MAP,監(jiān)測T_1~T_5時點的SVV、CO、SV及術(shù)中血流動力學(xué)的波動情況。記錄術(shù)中液體出入量、全麻藥物用量,術(shù)后蘇醒和拔管時間并隨訪患者術(shù)中知曉情況及有無麻醉相關(guān)并發(fā)癥。4應(yīng)用SPSS17.0統(tǒng)計軟件進行統(tǒng)計分析,計量資料以均數(shù)±標(biāo)準(zhǔn)差((?)±s)表示,組間相比采取用兩獨立樣本t檢驗,組內(nèi)比較采取重復(fù)測量方差分析,計數(shù)資料比較采用卡方檢驗。P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果1兩組患者的基本資料(年齡、性別、BMI、ASA分級等)差異無統(tǒng)計學(xué)意義(P0.05),具有臨床可比性。兩組患者入室后生命體征等指標(biāo)均衡可比,差異無統(tǒng)計學(xué)意義(P0.05)。2與T_0比較,在T_4、T_6時點兩組ACT_H、皮質(zhì)醇和Glu水平均顯著升高(P0.05或P0.01),證實了術(shù)中機體發(fā)生了較強的應(yīng)激反應(yīng);D組患者皮質(zhì)醇在T_4、T_6明顯低于L組(P0.05),說明較低BIS值對HPA軸的抑制更充分從而減少Cor的分泌。3與T_0比,L組患者HR在T_4~T_6明顯增加(P0.05或P0.01),MAP在T_1、T_2顯著下降(P0.05)在T_4~T_6增加(P0.05或P0.01);D組HR各時點較T_0無明顯改變(P0.05),MAP在T_1~T_5下降(P0.05或P0.01);同時D組HR在T_4~T_6明顯低于L組(P0.05),MAP在T_3~T_6低于L組(P0.05),D高血壓發(fā)生率低于L組(P0.05),說明BIS值維持在40~49能有效減輕老年胃腸手術(shù)患者血流動力學(xué)的波動。術(shù)中各時點的SVV、CO、SV,兩組患者差異無統(tǒng)計學(xué)意義(P0.05)。4 D組術(shù)中丙泊酚用量和補液量明顯多于L組,差異有統(tǒng)計學(xué)意義(P0.05),瑞芬太尼用量、出血量及尿量在兩組患者中,差異無統(tǒng)計學(xué)意義(P0.05)。D組蘇醒時間和拔管時間長于L組,差異有統(tǒng)計學(xué)意義(P0.05)。術(shù)后隨訪兩組患者均無術(shù)中知曉及麻醉相關(guān)并發(fā)癥發(fā)生。結(jié)論1在老年患者胃腸道手術(shù)中麻醉深度調(diào)控BIS值范圍在40~49較維持50~59減少應(yīng)激激素皮質(zhì)醇水平,更好的抑制機體的應(yīng)激反應(yīng)。2調(diào)控在BIS值范圍40~49可維持更平穩(wěn)的HR、MAP,減少血流動力學(xué)的波動。3調(diào)控BIS值在40~59均保證手術(shù)順利完成且無麻醉相關(guān)并發(fā)癥及術(shù)中知曉發(fā)生。但維持BIS值50~59可節(jié)省液體和丙泊酚用量,減少蘇醒及拔管時間,有助于老年人麻醉后的早期恢復(fù)。
[Abstract]:Objective to investigate the stress and hemodynamic parameters of the elderly patients undergoing elective gastroenteric surgery under different BIS values, and to explore the effects of different depth of anesthesia on the stress response and hemodynamics of the elderly patients with gastrointestinal surgery under BIS monitoring, and to provide a theoretical basis for the clinical regulation of anesthesia depth and the effective reduction of stress. Methods 1 according to method 1, 60 cases of elderly patients (65~85 years old) were selected from November 2015 to October 2016 in the Affiliated Hospital of North China Polytechnic University. The American anesthesiologist Association (ASA) classification was grade I ~ III, and the patients were divided into 2 groups (according to random number table method, n=30): L group (BIS value maintained 50~59), D group (BIS value maintained 40~49). The gel ratio was 2:1 rehydration (SVV) for the subclavicular venous blood per stroke change (SVV), and the serum cortisol (Cor), adrenocorticotropin (ACT_H), blood glucose (Glu) level before induction of anesthesia (T_0), and two groups of patients before the anesthesia induction (T_0), 120min (T_4) and 60min (T_6).3 after extubation after the operation. After endotracheal intubation (T_1), operation start (T_2), 60min (T_3) after operation, 120min (T_4) after operation, operation end (T_5), HR of 60min (T_6) after extubation, MAP. The intraoperative knowledge and the complications related complications of.4 were statistically analyzed with SPSS17.0 software, and the measurement data were measured with mean + standard deviation ((?) + s). Compared with two independent sample t tests, the group adopted repeated measurement of variance analysis, and counting data compared with chi square test.P0.05 was statistically significant. Results there was no significant difference in the basic data (age, sex, BMI, ASA classification, etc.) in 1 groups of patients (P0.05), and there was a clinical comparability. There was no statistically significant difference between the two groups after entering the room. There was no significant difference (P0.05),.2 and T_0, in T_4, T_6 time point two, and the level of cortisol and Glu increased significantly (P0.05 or P0.01). In the group D, the cortisol in T_4, T_6 was significantly lower than that of the L group (P0.05), indicating that the lower BIS value was more sufficient to reduce the HPA axis, thus reducing the.3 and T_0 ratio of Cor. 1); there was no obvious change in the time points of HR in group D (P0.05), MAP in T_1~T_5 (P0.05 or P0.01), while D group HR in T_4~T_6 was lower than that of L group, and the incidence of hypertension was lower than that of the group. SVV, CO, SV, there was no significant difference between the two groups (P0.05) the dosage of propofol and the amount of rehydration in the group.4 D were significantly more than those in the L group. The difference was statistically significant (P0.05). There was no significant difference between the dosage of remifentanil, the amount of bleeding and the amount of urine in the two groups (P0.05), the waking time and extubation time of the.D group were longer than those in the L group, the difference was statistically significant. Meaning (P0.05). Two groups of patients were followed up without intraoperative awareness and anesthesia related complications. Conclusion 1 in the elderly patients with gastrointestinal surgery, the range of anaesthesia in the range of BIS value is less than the 40~49 maintenance 50~59 to reduce the stress hormone cortisol level, better inhibition of the body's stress response.2 regulation in the BIS range 40~49 can maintain a more stable HR, M AP, reducing the fluctuation of hemodynamics.3 control BIS value in 40~59 ensure the smooth completion of the operation without anesthesia related complications and intraoperative awareness. But the maintenance of BIS value 50~59 can save the dosage of liquid and propofol, reduce the awakening and extubation time, and help the elderly to recover early after anesthesia.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
本文編號：2163410
[Abstract]:Objective to investigate the stress and hemodynamic parameters of the elderly patients undergoing elective gastroenteric surgery under different BIS values, and to explore the effects of different depth of anesthesia on the stress response and hemodynamics of the elderly patients with gastrointestinal surgery under BIS monitoring, and to provide a theoretical basis for the clinical regulation of anesthesia depth and the effective reduction of stress. Methods 1 according to method 1, 60 cases of elderly patients (65~85 years old) were selected from November 2015 to October 2016 in the Affiliated Hospital of North China Polytechnic University. The American anesthesiologist Association (ASA) classification was grade I ~ III, and the patients were divided into 2 groups (according to random number table method, n=30): L group (BIS value maintained 50~59), D group (BIS value maintained 40~49). The gel ratio was 2:1 rehydration (SVV) for the subclavicular venous blood per stroke change (SVV), and the serum cortisol (Cor), adrenocorticotropin (ACT_H), blood glucose (Glu) level before induction of anesthesia (T_0), and two groups of patients before the anesthesia induction (T_0), 120min (T_4) and 60min (T_6).3 after extubation after the operation. After endotracheal intubation (T_1), operation start (T_2), 60min (T_3) after operation, 120min (T_4) after operation, operation end (T_5), HR of 60min (T_6) after extubation, MAP. The intraoperative knowledge and the complications related complications of.4 were statistically analyzed with SPSS17.0 software, and the measurement data were measured with mean + standard deviation ((?) + s). Compared with two independent sample t tests, the group adopted repeated measurement of variance analysis, and counting data compared with chi square test.P0.05 was statistically significant. Results there was no significant difference in the basic data (age, sex, BMI, ASA classification, etc.) in 1 groups of patients (P0.05), and there was a clinical comparability. There was no statistically significant difference between the two groups after entering the room. There was no significant difference (P0.05),.2 and T_0, in T_4, T_6 time point two, and the level of cortisol and Glu increased significantly (P0.05 or P0.01). In the group D, the cortisol in T_4, T_6 was significantly lower than that of the L group (P0.05), indicating that the lower BIS value was more sufficient to reduce the HPA axis, thus reducing the.3 and T_0 ratio of Cor. 1); there was no obvious change in the time points of HR in group D (P0.05), MAP in T_1~T_5 (P0.05 or P0.01), while D group HR in T_4~T_6 was lower than that of L group, and the incidence of hypertension was lower than that of the group. SVV, CO, SV, there was no significant difference between the two groups (P0.05) the dosage of propofol and the amount of rehydration in the group.4 D were significantly more than those in the L group. The difference was statistically significant (P0.05). There was no significant difference between the dosage of remifentanil, the amount of bleeding and the amount of urine in the two groups (P0.05), the waking time and extubation time of the.D group were longer than those in the L group, the difference was statistically significant. Meaning (P0.05). Two groups of patients were followed up without intraoperative awareness and anesthesia related complications. Conclusion 1 in the elderly patients with gastrointestinal surgery, the range of anaesthesia in the range of BIS value is less than the 40~49 maintenance 50~59 to reduce the stress hormone cortisol level, better inhibition of the body's stress response.2 regulation in the BIS range 40~49 can maintain a more stable HR, M AP, reducing the fluctuation of hemodynamics.3 control BIS value in 40~59 ensure the smooth completion of the operation without anesthesia related complications and intraoperative awareness. But the maintenance of BIS value 50~59 can save the dosage of liquid and propofol, reduce the awakening and extubation time, and help the elderly to recover early after anesthesia.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
【參考文獻】
相關(guān)期刊論文 前10條
1 洪毅;葉建榮;韓寶義;鄭宏;;每搏變異度聯(lián)合左室射血時間用于老年冠心病患者胃腸道手術(shù)中容量治療的臨床效果[J];臨床麻醉學(xué)雜志;2015年09期
2 紀(jì)金芬;錢敏;鐘國云;李東;張國平;;腦電雙頻指數(shù)在老年患者胃癌根治術(shù)中的臨床應(yīng)用[J];臨床麻醉學(xué)雜志;2014年12期
3 王濤;程志新;孟盡海;;不同麻醉方法對腹腔鏡膽囊切除術(shù)患者圍手術(shù)期應(yīng)激反應(yīng)的影響[J];寧夏醫(yī)科大學(xué)學(xué)報;2014年10期
4 徐鵬;沈杰;張富軍;;麻醉深度監(jiān)測對手術(shù)患者臨床預(yù)后的影響[J];上海醫(yī)學(xué);2014年10期
5 黃達(dá);王東信;;腦電雙頻指數(shù)監(jiān)測臨床應(yīng)用的新進展[J];國際麻醉學(xué)與復(fù)蘇雜志;2014年09期
6 王毅源;陳元良;胡崇輝;;不同麻醉深度對腹腔鏡膽囊切除術(shù)老年患者認(rèn)知功能及應(yīng)激反應(yīng)的影響[J];全科醫(yī)學(xué)臨床與教育;2014年04期
7 田可耘;康茵;鄧龍姣;劉紅;李海風(fēng);王志鵬;趙國棟;;不同麻醉深度對老年腸癌手術(shù)患者應(yīng)激反應(yīng)的影響[J];南方醫(yī)科大學(xué)學(xué)報;2014年05期
8 周濤;郭善亮;張明生;;目標(biāo)導(dǎo)向液體治療在老年患者胃腸道手術(shù)中的應(yīng)用[J];臨床麻醉學(xué)雜志;2013年10期
9 康茵;鄧龍姣;趙國棟;劉紅;李海風(fēng);田可耘;;Narcotrend監(jiān)測不同麻醉深度對老年腸癌患者術(shù)后早期認(rèn)知功能障礙的影響[J];臨床麻醉學(xué)雜志;2013年08期
10 葉曉明;葉軍青;徐海濤;袁紅斌;;不同麻醉方法與深度對老年髖關(guān)節(jié)置換術(shù)患者術(shù)后早期認(rèn)知功能的影響[J];臨床軍醫(yī)雜志;2013年03期
相關(guān)碩士學(xué)位論文 前2條
1 張兆偉;不同麻醉深度對2型糖尿病患者血糖及應(yīng)激反應(yīng)的影響[D];延安大學(xué);2010年
2 陸正荷;每搏變異度（SVV）指導(dǎo)胃腸道手術(shù)容量管理的研究[D];浙江大學(xué);2008年
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