右美托咪定、异丙酚、咪达唑仑对ICU老年患者心功能的影响

发布时间：2018-01-19 05:02

本文关键词： 右美托咪定异丙酚咪达唑仑心功能超声心动图　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的观察右美托咪定、异丙酚、咪达唑仑对重症监护室（ICU）老年患者心功能的影响。方法选取消化道肿瘤术后呼吸功能不全的ICU老年患者30例，ASA分级II或III级，随机分入右美托咪定组、异丙酚组、咪达唑仑组，每组10例。入室后2小时判断患者已经麻醉苏醒后予以镇静。右美托咪定组静脉泵注负荷剂量为1ug/kg的右美托咪定10min，维持剂量为0.4ug/kg/h，调整剂量时每次增减0.1ug/kg/h。异丙酚组静脉泵注初始血浆浓度为0.5ug/ml的异丙酚，诱导时间为10min，调整剂量时每次增减0.1ug/ml。咪达唑仑组静脉泵注初始血浆浓度为30ng/ml的咪达唑仑，诱导时间为10min，调整剂量时每次增减10ng/ml。各组每隔30min进行改良OAA/S评分并调整剂量，使评分保持在3~4级。分别在镇静前（T0）、镇静60min（T1）、镇静120min（T2）、镇静180min（T3）4个时间点，，用超声心动图监测患者的心功能情况。结果右美托咪定组T1时间点的射血分数（EF）、缩短分数（FS）较异丙酚组升高（P＜0.05）；与镇静前T0时间点比较，异丙酚组T1、T3时间点的二尖瓣血流E峰速度下降（P＜0.05）；异丙酚组T1时间点的二尖瓣血流E峰速度较右美托咪定组、咪达唑仑组下降（P＜0.05）；其余心功能指标组间、组内比较，差异无统计学意义（P＞0.05)。结论EF值、E峰速度变化受多种因素影响，统计有差异，但具体临床应用中影响是微乎其微的。故浅镇静剂量的右美托咪定、异丙酚、咪达唑仑对心室收缩、舒张功能无明显影响。
[Abstract]:Objective to observe the effects of dexmetomidine, propofol and midazolam on cardiac function in elderly patients with ICU. Methods Thirty elderly ICU patients with dyspnea after digestive tract tumor operation were randomly divided into dexmetomidine group, propofol group and midazolam group. 10 patients in each group were treated with sedation after 2 hours of anaesthesia recovery. The dexmetomidine group was injected with dexmetomidine at a dose of 1ugm-1 / kg for 10 minutes. The maintenance dose was 0.4ugr / kg / h, and the dosage was increased or decreased by 0.1ug- / kg / h. Propofol was injected intravenously with propofol with initial plasma concentration of 0.5ugrml. The induction time was 10 min, and the initial plasma concentration of 30 ng / ml midazolam was injected by intravenous pump, and the induction time was 10 min. The dosage was increased or decreased by 10 ng / ml every time. The OAA/S score was improved every 30 minutes and the dose was adjusted to keep the score at 3ng / ml, respectively before sedation (T0). Cardiac function was monitored by echocardiography at 4 time points of sedation (60 min, 120 min, T 2, 180 min, T 3). Results compared with propofol group, the ejection fraction (EFF) and the shortening fraction (FSs) of dexmetomidine group were significantly higher than those of propofol group (P < 0.05). The E peak velocity of mitral flow in propofol group was decreased at T 1 T 3 time point compared with that at T 0 time point before sedation (P < 0 05). The E peak velocity of mitral flow in propofol group was lower than that in right metoimidine group and midazolam group (P < 0.05). There was no significant difference in other cardiac function indexes between groups (P > 0.05). Conclusion the changes of EF value and E peak velocities are influenced by many factors, and there are statistical differences, but the effect in clinical application is very little. So the superficial sedative dosage of dexmetomidine and propofol. Midazolam had no effect on ventricular systolic and diastolic function.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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