【摘要】：下肢手術(shù)和下腹部手術(shù)多選擇在椎管內(nèi)麻醉下完成。手術(shù)過程中患者始終處于清醒狀態(tài),容易出現(xiàn)精神緊張和焦慮。尤其對(duì)于剖宮產(chǎn)產(chǎn)婦,其不僅對(duì)手術(shù)產(chǎn)生恐懼和焦慮,還要時(shí)刻關(guān)注胎兒。在胎兒娩出后,產(chǎn)婦更加容易出現(xiàn)情緒激動(dòng)和交感神經(jīng)興奮,并且胎兒娩出后常需使用縮宮素,能夠進(jìn)一步影響產(chǎn)婦,加重應(yīng)激反應(yīng)。右美托咪定作為一種新型、高選擇性的α2受體激動(dòng)劑,具有催眠、鎮(zhèn)靜、鎮(zhèn)痛和抗焦慮等作用,能夠有效減少或消除不良情緒和應(yīng)激反應(yīng)。年齡是影響藥物藥代動(dòng)力學(xué)和藥效動(dòng)力學(xué)的重要因素之一,患者對(duì)藥物的敏感性隨年齡增長而增加。目前有關(guān)右美托咪定用于女性患者的有效鎮(zhèn)靜劑量研究較少,所以本研究旨在探討年齡對(duì)女性患者右美托咪定有效鎮(zhèn)靜量效關(guān)系的影響以及分娩后產(chǎn)婦和非妊娠婦女右美托咪定有效鎮(zhèn)靜劑量的差異。目的一、探討年齡因素對(duì)女性患者單次泵注右美托咪定有效鎮(zhèn)靜量效關(guān)系的影響。二、探討分娩后產(chǎn)婦和非妊娠婦女右美托咪定有效鎮(zhèn)靜劑量的差異。方法選取腰硬聯(lián)合麻醉下行下肢手術(shù)女性患者,根據(jù)年齡劃分為3組,Y組(20～35歲)、M組(40～60歲)和O組(65～79歲)。選取腰硬聯(lián)合麻醉下行剖宮產(chǎn)產(chǎn)婦為產(chǎn)婦組,非妊娠婦女患者行下腹部手術(shù)為非妊娠婦女組。產(chǎn)婦組待胎兒和胎盤娩出后,其他各組在確定麻醉平面后即可開始單次恒速泵注右美托咪定15min。每一例患者的給藥劑量由改良二階段序貫法確定。通過第二階段轉(zhuǎn)折點(diǎn)中點(diǎn)的均值計(jì)算各組右美托咪定有效鎮(zhèn)靜的半數(shù)有效劑量(ED50)。同時(shí)通過Probit分析法計(jì)算各組右美托咪定有效鎮(zhèn)靜的ED50、95%有效劑量(ED95)及其95%置信區(qū)間(CI)。結(jié)果Y組、M組和O組右美托咪定有效鎮(zhèn)靜的ED50分別為(0.96±0.35)μg/kg、(0.99±0.35)μg/k 和(0.68±0.46)μg/kg。使用 Probit 分析法計(jì)算 Y 組、M 組和 O組ED50及其95%CI分別為 0.98(0.93～1.03μg/kg)、0.96(0.92～1.00μg/kg)和0.66 μg/kg(0.63～0.69 μg/kg);ED95 及其 95%CI 分別為 1.13 μg/kg(1.06～1.30μg/kg),1.11 μg/kg(1.05～1.26 μg/kg)和 0.76 μg/kg(0.72～0.87 μg/kg)。產(chǎn)婦組和非妊娠婦女組右美托咪定有效鎮(zhèn)靜的ED50分別為(1.73±0.46)μg/kg和(1.03±0.46)μg/kg。使用Probit分析法計(jì)算產(chǎn)婦組和非妊娠婦女組右美托咪定有效鎮(zhèn)靜ED50及其 95%CI 為 1.69 μg/kg(1.61～1.79 μg/kg)和 0.98 μg/kg(0.92～1.02 μg/kg);ED95 及其 95%CI 為 1.93 μg/kg(1.82～2.39 μg/kg)和 1.11 μg/kg(1.05～1.35μg/kg)。Y組與M組的ED50差異無統(tǒng)計(jì)學(xué)意義(P0.0167);與Y組和M組比較,O組ED50降低(P0.0167)。產(chǎn)婦組ED50明顯大于非妊娠婦女組(P0.05)。結(jié)論右美托咪定用于中、青年女性患者有效鎮(zhèn)靜時(shí)的ED50無差異,而老年女性患者的ED50顯著小于中青年女性患者。另外,產(chǎn)婦所需右美托咪定有效鎮(zhèn)靜ED50明顯大于非妊娠婦女。
[Abstract]:Lower limb surgery and lower abdominal surgery were performed under intraspinal anesthesia. During the operation, the patient is always awake and prone to mental stress and anxiety. Especially for cesarean section, it not only produces fear and anxiety, but also focuses on the fetus. After the delivery of the fetus, the parturient is more prone to emotional and sympathetic excitement, and the fetus often needs to use oxytocin after delivery, which can further affect the parturient and aggravate the stress response. As a novel and highly selective 偽 2 receptor agonist, dexmetidine has the effects of hypnosis, sedation, analgesia and anti-anxiety, which can effectively reduce or eliminate adverse emotions and stress reactions. Age is one of the most important factors affecting pharmacokinetics and pharmacokinetics. At present, there are few studies on the effective sedatives of dexmetidine for female patients. The purpose of this study was to investigate the effect of age on the effective sedative effect of dexmetomidine in female patients and the difference of the effective sedative dose between postpartum and non-pregnant women. Objective: to investigate the effect of age factors on the effective sedative response of dexmetidine by single pump in female patients. Second, to explore the difference of dexmetomidine effective sedatives between postpartum and non-pregnant women. Methods female patients undergoing lower extremity operation under combined spinal-epidural anesthesia were divided into three groups according to their age: group Y (20 ~ 35 years old), M group 40 ~ 60 years old) and O group (65 ~ 79 years old). Cesarean section under combined spinal-epidural anesthesia was selected as the parturient group, and non-pregnant women underwent lower abdominal surgery. After the delivery of fetus and placenta, the other groups could begin to infuse dexmetomidine for 15 mins after the anaesthesia level was determined. The dosage of each patient was determined by an improved two-stage sequential method. The half effective dose (ED50) of dexmetomidine effective sedation was calculated by the mean of the middle point of the second stage turning point. At the same time, the effective ED50,95% dose (ED95) and 95% confidence interval (CI).) of dexmetidine were calculated by Probit analysis in each group. Results the ED50 of dexmetidine in group Y, M and O were (0.96 鹵0.35) 渭 g / kg, (0.99 鹵0.35) 渭 g / kg and (0.68 鹵0.46) 渭 g / kg, respectively. Probit analysis was used to calculate ED50 and 95%CI in group Y, M and O were 0.98 (0.93 渭 g/kg), 0.96 (0.92 渭 g/kg) and 0.66 渭 g/kg (0.63 渭 g/kg), respectively. ED95 and 95%CI were 1.13 渭 g/kg (1.06 渭 g/kg, 1.30 渭 g/kg), 1.11 渭 g/kg (1.05N 1.26 渭 g/kg) and 0.76 渭 g/kg (0.72 渭 g/kg, 0.87 渭 g/kg), respectively. The effective sedative ED50 of dexmetomidine was (1.73 鹵0.46) 渭 g/kg and (1.03 鹵0.46) 渭 g / kg in puerpera and non-pregnant women, respectively. Probit analysis was used to calculate the effective sedation of ED50 and its 95%CI were 1.69 渭 g/kg (1.61V 1.79 渭 g/kg) and 0.98 渭 g/kg (0.92U 1.02 渭 g/kg) in pregnant women and non-pregnant women. The ED50 of ED95 and 95%CI were 1.93 渭 g/kg (1.82 鹵2.39 渭 g/kg) and 1.11 渭 g/kg (1.05 ~ 1.35 渭 g/kg). Y), respectively. There was no significant difference in ED50 between group M and group M (P0.0167). Compared with group Y and group M, ED50 in group O decreased (P 0.0167). ED50 in parturient group was significantly higher than that in non pregnant women group (P 0.05). Conclusion there is no difference in ED50 between young women and young women, but the ED50 of elderly women is significantly lower than that of young and middle-aged women. In addition, the effective sedation of ED50 by dexmetomidine was significantly higher in parturient than in non-pregnant women.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張?chǎng)?吳秀英;;不同劑量右美托咪定對(duì)焦慮患者情緒及記憶影響的比較[J];中國醫(yī)科大學(xué)學(xué)報(bào);2016年03期

2 李雪萍;李云勝;劉才堂;蔡米麗;周麗麗;劉克玄;;右美托咪定抑制老年患者氣管插管反應(yīng)半數(shù)有效劑量的序貫研究[J];廣西醫(yī)學(xué);2015年12期

3 李奇紅;王文偉;楊彩霞;柯賁白;;右美托咪定減少卡前列素氨丁三醇剖宮產(chǎn)術(shù)中不良反應(yīng)的效果觀察[J];中國婦幼保健;2015年35期

4 汪靈芝;廖敏;賴永東;何榮芝;;不同劑量右美托咪定應(yīng)用于剖宮產(chǎn)術(shù)中預(yù)防卡前列素氨丁三醇不良反應(yīng)的對(duì)比研究[J];現(xiàn)代醫(yī)院;2015年07期

5 李榮華;;右美托咪定在腰麻-硬膜外聯(lián)合麻醉下剖宮產(chǎn)術(shù)的臨床應(yīng)用[J];醫(yī)學(xué)理論與實(shí)踐;2015年09期

6 劉敏;林全陽;;右美托咪定用于子宮下段剖腹產(chǎn)椎管麻醉鎮(zhèn)靜的效果[J];醫(yī)學(xué)理論與實(shí)踐;2014年24期

7 魏曉佳;戴曉云;范冰冰;陳燕;許忠玲;;剖宮產(chǎn)患者輔用右美托咪定對(duì)新生兒的影響[J];江蘇醫(yī)藥;2014年22期

8 莫家全;張敏森;黃堅(jiān);占文武;黃曉華;;右美托咪定在剖宮產(chǎn)手術(shù)中的鎮(zhèn)靜效果及對(duì)新生兒Apgar評(píng)分的影響[J];中國醫(yī)藥導(dǎo)報(bào);2014年24期

9 章冉冉;陽國平;裴奇;彭金富;陽喜定;劉莉;;右美托咪定在特殊人群中的藥代動(dòng)力學(xué)研究進(jìn)展[J];中國臨床藥理學(xué)雜志;2014年07期

10 倪燕;桂波;蔣秀紅;丁正年;;小劑量右美托咪定預(yù)防卡前列素誘發(fā)剖宮產(chǎn)術(shù)患者不良反應(yīng)的效果[J];中華麻醉學(xué)雜志;2014年07期

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