右美托咪定在妇科肿瘤腹腔镜手术中的临床应用

发布时间：2018-03-18 14:13

本文选题：右美托咪定　切入点：腹腔镜手术　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的评价右美托咪定在妇科肿瘤腹腔镜手术中应用的安全性及对患者全麻苏醒期的影响以及不良反应发生情况。方法选择全麻下择期行腹腔镜下妇科肿瘤根治术患者45例,年龄18~65岁,ASA I~II级,术中采用靶控输注瑞芬太尼及丙泊酚的麻醉方案,随机分成3组(n=15),D1组(0.3ug/kg/h右美托咪定组):从麻醉诱导到手术结束前30分钟,持续输注0.3ug/kg/h右美托咪定;D2组(0.4ug/kg/h右美托咪定组):从麻醉诱导到手术结束前30分钟,持续输注0.4ug/kg/h右美托咪定;C组为对照组。记录入室时(T1)、手术结束时(T2)、拔管前(T3)、拔管时(T4)、拔管后5min(T5)、拔管后10min(T6)及拔管后30min(T7)的收缩压(SBP)、舒张压(DBP)、心率(HR)、平均动脉压(MAP);记录患者T3~T7时点Ramsay镇静评分、Riker镇静-躁动评分及呛咳评分;记录麻醉药用量、呼吸恢复时间、苏醒时间、拔管时间;记录术中心率50次/分、低血压、高血压及术后呼吸抑制、恶心呕吐、寒战等不良反应的发生率。结果(1)与C组比较,D1、D2组丙泊酚及瑞芬太尼用量明显减少,差异有统计学意义(P0.05);D2组与D1组的丙泊酚及瑞芬太尼用量差异无统计学意义(P0.05)(2)与C组比较,T3、T4、T5时点D1、D2组的Ramsay镇静评分升高,T3~T7时点D2组的Ramsay镇静评分升高,T3、T4时点D1、D2组患者的Riker镇静-躁动评分SAS降低,T3时点D1、D2组呛咳评分降低,差异具有统计学意义(P0.05);与D1组比较,T3、T4、T5时点D2组的Ramsay镇静评分更高,差异具有统计学意义(P0.05),D2组的Riker镇静-躁动评分SAS、T3时点D2组呛咳评分差异无统计学意义(P0.05);(3)与C组比较,T4时点D2组的SBP、DBP、MAP、HR值降低及D1组的SBP、DBP值降低,差异具有统计学意义(P0.05);T3、T4、T5时点D1、D2组的值基本低于C组,D1、D2组拔管期的血流动力学比C组更加平稳。(4)三组不良反应发生率无明显差别。结论腹腔镜下妇科肿瘤根治手术术中持续输注0.3ug/kg/h、0.4ug/kg/h的右美托咪定可有效抑制全身麻醉苏醒拔管期应激反应,且在稳定血流动力学的同时又达到良好的镇静效果;0.4ug/kg/h右美托咪定组在苏醒期的镇静效果优于0.3ug/kg/h右美托咪定组,提高了患者苏醒拔管期的舒适度,同时并未增加不良反应的发生率。
[Abstract]:Objective to evaluate the safety of dexmetomidine in gynecological tumor laparoscopic surgery and its influence on the recovery period of general anesthesia and adverse reactions. Methods 45 patients with gynecologic tumor underwent laparoscopic radical gynecologic tumor surgery under general anesthesia. The patients, aged 18 to 65, were treated with target-controlled infusion of remifentanil and propofol. They were randomly divided into 3 groups: group D: 0.3ugr / kg / h dexmetomidine: 30 minutes from induction of anesthesia to the end of operation. Continuous infusion of 0.3 ugr / kg / h dexmetomidine D2 group: 30 minutes from anesthesia induction to the end of the operation. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HRT), mean arterial pressure (MAPP) were recorded in group C (0.4 ugg / kg / h) as control group. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HRT), mean arterial pressure (MAPP) were recorded at the end of operation, before extubation, at 5 min after extubation, 5 min after extubation, 10 min after extubation, 10 min after extubation, 30 min after extubation, and 30 min after extubation, the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HRT) and mean arterial pressure (MAPP) were recorded. Ramsay sedation score, Riker sedation-restlessness score and cough score at T _ 3 and T _ 7; The dosage of anesthetic, the time of respiratory recovery, the time of waking up, the time of extubation, the heart rate of 50 / min, hypotension, hypertension and postoperative respiratory depression, nausea and vomiting were recorded. Results compared with group C, the dosage of propofol and remifentanil in D1D 2 group decreased significantly. There was no significant difference in the dosage of propofol and remifentanil between group D 2 and group D1. There was no significant difference in the dosage of propofol and remifentanil between group D 2 and group D 1. There was no significant difference between group C and group C (P < 0.05). The Ramsay sedation score of group D 2 was higher than that of group C (P < 0.01). The Ramsay sedation score of group D _ 2 was higher than that of group C at T _ 3, T _ 4, T _ 2, T _ 3, T _ 7, D _ 2 and D _ 1T _ 4. The Riker sedative-restlessness score (SAS) decreased at T _ 3 and D _ 1 / D _ 2 group, and the score of cough was decreased in D _ 1 / D _ 2 group. Compared with D1 group, the Ramsay sedation score of D2 group was higher than that of D1 group. There was no significant difference in Riker sedation and restlessness score between group D 2 and group C (P 0.05). There was no significant difference in score of cough and choking between group D 2 and group C (P < 0.05). The HR value of SBP DBP in group D 2 at T 4 was lower than that in group D 1, and that in group D 1 was lower than that in group D 1. There was no significant difference in the incidence of adverse reactions among the three groups. Conclusion there is no significant difference in the incidence of adverse reactions among the three groups. Conclusion Laparoscopic radical resection of gynecological tumors is not a significant difference among the three groups. Continuous intraoperative infusion of 0.3ugr / kg / kg / h dexmetomidine could effectively inhibit the stress response during the extubation phase of general anesthesia. At the same time of stabilizing hemodynamics and achieving good sedative effect, the sedative effect of the right metoimidine group was better than that of the 0.3ugr / kg / h dexmetomidine group during the recovery period, which improved the comfort of the patients during the extubation period. At the same time, there was no increase in the incidence of adverse reactions.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R737.3

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