本文選題：腹腔鏡手術(shù)　切入點(diǎn)：頭低腳高位　出處：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的研究地塞米松對(duì)頭低位手術(shù)術(shù)后恢復(fù)期蘇醒質(zhì)量的影響。在麻醉蘇醒期應(yīng)用Narcotrend監(jiān)測(cè)對(duì)患者的意識(shí)恢復(fù)情況作出客觀評(píng)價(jià)。研究方法1研究對(duì)象經(jīng)患者及家屬同意并通過醫(yī)學(xué)倫理委員會(huì)批準(zhǔn),選擇大連市中心醫(yī)院2015年4月至2016年11月期間,于全憑靜脈麻醉下行腹腔鏡輔助下直腸癌根治術(shù)患者58例,隨機(jī)分成兩組,對(duì)照組(A組)和地塞米松組(B組),每組29名患者(n=29)。2研究方法患者入室后常規(guī)開放靜脈通路,監(jiān)測(cè)無創(chuàng)血壓,心率,指脈氧飽和度,Narcotrend麻醉深度監(jiān)測(cè),橈動(dòng)脈穿刺置管監(jiān)測(cè)動(dòng)脈血壓。根據(jù)患者體重常規(guī)麻醉誘導(dǎo)。術(shù)中根據(jù)Narcotrend監(jiān)測(cè)數(shù)值調(diào)整丙泊酚靶濃度,使Narcotrend監(jiān)測(cè)數(shù)值保持于D水平,于頭低位30分鐘后兩組分別輸注生理鹽水2毫升(A組),10毫克地塞米松2毫升(B組),必要時(shí)追加羅庫溴銨30毫克,手術(shù)結(jié)束前30min輸注特耐40毫克,縫皮前停止輸注所有的藥物。3觀察與記錄3.1 一般資料:性別,年齡,ASA分級(jí),體重,頭低位時(shí)間,術(shù)中輸液量,尿量,術(shù)后8小時(shí)患者血清S100β蛋白水平。3.2記錄兩組患者術(shù)后恢復(fù)期Narcotrend指數(shù)由D變?yōu)锳的時(shí)間,有無蘇醒期躁動(dòng)。3.3記錄兩組患者術(shù)后恢復(fù)期GCS評(píng)分。4統(tǒng)計(jì)學(xué)分析采用SPSS12.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。計(jì)量資料均以x ±SD表示,采用t檢驗(yàn)進(jìn)行組間差異的顯著性檢驗(yàn);計(jì)數(shù)資料采用X2檢驗(yàn)。P0.05認(rèn)為有統(tǒng)計(jì)學(xué)差異。結(jié)果1兩組患者的一般情況,如性別,年齡,ASA分級(jí),體重,手術(shù)時(shí)間,頭低位時(shí)間,術(shù)中補(bǔ)液量,尿量,組間比較無統(tǒng)計(jì)學(xué)差異。2兩組患者術(shù)后恢復(fù)期Narcotrend指數(shù)由D變?yōu)锳所需時(shí)間,組間比較差異有統(tǒng)計(jì)學(xué)意義。地塞米松組術(shù)后GCS評(píng)分較對(duì)照組高。3患者術(shù)后8小時(shí)血清S100 β蛋白濃度,組間比較無統(tǒng)計(jì)學(xué)意義。結(jié)論1在腹腔鏡輔助直腸癌根治術(shù)中應(yīng)用地塞米松,可以提高麻醉蘇醒質(zhì)量。2在麻醉恢復(fù)期應(yīng)用Narcotrend監(jiān)測(cè),可以有效,客觀的反映患者意識(shí)狀況,縮短麻醉恢復(fù)時(shí)間。
[Abstract]:Objective to study the effect of dexamethasone on recovery quality after head-low operation.The consciousness recovery of patients was evaluated objectively by Narcotrend monitoring during anaesthesia recovery period.Methods 1 58 patients undergoing laparoscopic radical resection of rectal cancer were selected from April 2015 to November 2016 in Dalian Central Hospital with the consent of the patients and their families and the approval of the Medical Ethics Committee.Two groups were randomly divided into two groups (control group A) and dexamethasone group B (29 patients in each group). The patients in each group were studied by routine opening of venous pathway after entering the room to monitor noninvasive blood pressure, heart rate, oxygen saturation of finger pulse and Narcotrend anesthetic depth.Radial artery puncture was used to monitor arterial blood pressure.Induction of routine anesthesia according to the patient's weight.During the operation, the target concentration of propofol was adjusted according to the value of Narcotrend monitoring to keep the monitoring value of Narcotrend at D level.Observation and recording of 3.1 general data: sex, age, ASA grade, weight, head-down time, intraoperative infusion volume, urine volume,8 hours after operation, the serum S100 尾 protein level. 3. 2 recorded the time of Narcotrend index changing from D to A in the recovery period of the two groups.Whether there was restlessness in recovery period or not, the GCS score of the two groups in convalescence period was recorded. The statistical analysis was carried out by SPSS12.0 software.The measurement data were expressed as x 鹵SD, and the t test was used for the significant test of the difference between groups, and the count data was calculated by X2 test. P05 showed that there was statistical difference.Results 1 the general condition of the two groups, such as gender, age, ASA grade, weight, operation time, head-low time, intraoperative fluid volume, urine volume, etc.There was no significant difference between the two groups in the time required for the Narcotrend index to change from D to A in the recovery period of the two groups, and the difference between the two groups was statistically significant.The postoperative GCS score of dexamethasone group was higher than that of control group. The serum S100 尾 protein concentration in dexamethasone group was higher than that in control group at 8 hours postoperatively.Conclusion 1 the application of dexamethasone in laparoscopically assisted radical resection of rectal cancer can improve the quality of anaesthesia recovery by using Narcotrend monitoring in the recovery stage of anesthesia, which can effectively and objectively reflect the patients' consciousness and shorten the recovery time of anesthesia.
【學(xué)位授予單位】：大連醫(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;R735.37
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本文編號(hào)：1716290