右美托咪定对腹部手术患者全身麻醉苏醒期呼吸、血流动力学、BIS值的影响

发布时间：2018-01-24 10:20

  本文关键词： 右美托咪定 气管拔管 血流动力学 呼吸 BIS值　出处：《职业卫生与病伤》2016年02期 　论文类型：期刊论文

【摘要】：目的探讨腹部术中全麻处理时,右美托咪定对患者苏醒期血流动力学、呼吸、BIS值的影响。方法选取宜宾市矿山急救医院2014-01/2015-06接诊的择期全麻开腹手术患者57例,按照随机数字排列法将其分为两组,其中对照组患者27例,给予10ml生理盐水,观察组患者27例,给予其0.6μg/kg右美托咪定,术中以氧气、七氟醚、芬太尼、阿曲库铵行维持麻醉,手术结束前30min,经静脉泵入试验药物。观测两组患者手术指标、各时间点血流动力学、呼吸、BIS值变化,测定镇痛效果,记录镇痛时间。结果两组患者手术时间、麻醉时间、尿量、丙泊酚与芬太尼使用剂量、术中输液量与出血量对比差异无统计学意义(P0.05);两组入室时、用药时、用药后5min SBP、DBP对比差异无统计学意义(P0.05);观察组用药后10min SBP高于对照组,拔管时、拔管后3min、5min、10min SBP较之对照组更低(P0.05);观察组拔管时、拔管后3min、5min、10min DBP较之对照组更低(P0.05),两组入室时、用药时、用药后5min HR对比差异无统计学意义(P0.05);观察组用药后10min、拔管时、拔管后3min、5min、10min HR较之对照组更低(P0.05);两组入室时RPP对比差异(P0.05);观察组拔管时、拔管后1min、3min、5min RPP较之对照组更低(P0.05);两组入室时、用药时、用药后5min、10min、拔管时、拔管后3min、5min、10min BIS值测定结果对比无差异(P0.05);观察组自主呼吸恢复时间更短,术后2h VAS评分更低,术后镇痛时间更长(P0.05);观察组手术费与对照差异无统计学意义(P0.05),但住院时间更短(P0.05);对照组不良反应率为14.81%,观察组不良反应率为7.41%(P0.05)。结论腹部手术全麻处理中,运用右美托咪定可有效减轻患者的拔管应激反应,尤其是在稳定血流动力学上效果显著,且不会对呼吸造成过大影响,同时还具有较好的镇痛效果。
[Abstract]:Objective to investigate the effects of dexmetomidine on hemodynamics and respiration during abdominal anesthesia. Methods 57 patients undergoing elective general anesthesia operation in Yibin Mine Emergency Hospital 2014-01 / 2015-06 were divided into two groups according to random number arrangement. The control group (n = 27) received 10 ml normal saline, while the observation group (n = 27) received 0.6 渭 g / kg dexmetidine with oxygen, sevoflurane and fentanyl during the operation. Atracurium was administered with maintenance anesthesia, 30 minutes before the end of the operation, and then administered intravenously into the trial drug. The indexes of operation, hemodynamics at each time point, the changes of BIS in respiratory system and the analgesic effect were measured. Results there was no significant difference in operation time, anesthesia time, urine volume, dosage of propofol and fentanyl, intraoperative infusion volume and blood loss between the two groups (P 0.05). There was no significant difference in SBPnDBP between the two groups at 5 min after the treatment, and there was no significant difference in DBP between the two groups (P 0.05). The SBP of the observation group was significantly lower than that of the control group (P 0.05), and the SBP of the observation group was significantly lower than that of the control group (P 0.05) 3 minutes after extubation and 5 minutes after the extubation. During extubation, the DBP of the observation group was lower than that of the control group 3 minutes after extubation and 5 minutes after extubation. There was no significant difference in HR at 5 min after treatment (P 0.05). The HR in the observation group was lower than that in the control group at 10 min after medication, 5 min after extubation and 3 min after extubation. The difference of RPP between the two groups was P0.05A; During extubation, the RPP of the observation group was lower than that of the control group at 3 minutes and 5 minutes after extubation. There was no significant difference in BIS values between the two groups at the time of entering the room, 5 minutes after the administration of drugs and 3 minutes after extubation, and 5 minutes after extubation, and there was no difference between the two groups in the determination of BIS value (P 0.05). In the observation group, the recovery time of spontaneous respiration was shorter, the VAS score was lower at 2 hours after operation, and the postoperative analgesia time was longer than that of the control group (P 0.05). The operating expenses of the observation group were not significantly different from those of the control group (P 0.05), but the hospitalization time was shorter than that of the control group (P 0.05). The adverse reaction rate was 14.81 in the control group and 7.41 in the observation group. Dexmetomidine can effectively reduce the extubation stress response, especially in stabilizing hemodynamics, and does not have too much effect on respiration, but also has a good analgesic effect.
【作者单位】： 四川省宜宾市矿山急救医院;
【分类号】：R614.2
【正文快照】： 在全麻苏醒期气管拔管时,会对机体产生刺激,致使其出现强烈的应激反应,并引起下丘脑-垂体-肾上腺皮质轴兴奋,使得患者出现血压上升、心动过速、心肌耗氧量增加等表现,极不利于患者的愈后和转归[1]。右美托咪定是一种新型的α2肾上腺素能受体激动剂,半衰期大约为6 min,消除半衰

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