不同剂量舒芬太尼复合丙泊酚静脉全麻对术后谵妄发生率的影响

发布时间：2018-01-25 02:09

本文关键词： 不同剂量舒芬太尼丙泊酚静脉全麻术后谵妄　出处：《中外医学研究》2015年34期 　论文类型：期刊论文

【摘要】：目的:分析和探讨不同剂量舒芬太尼复合丙泊酚静脉全麻方法对预防术后谵妄发生的效果。方法:选择笔者所在医院2014年1月-2015年1月接受腹腔镜下行全麻胆囊切除手术的120例患者作为研究对象,按照随机抽签的方式将其划分为三组,各40例。并给予不同剂量舒芬太尼治疗,其中A组患者舒芬太尼用量为0.4μg/kg,B组患者舒芬太尼用量为0.5μg/kg,C组患者舒芬太尼用量为0.6μg/kg,此外在三组患者麻醉过程中同时给予丙泊酚3μg/ml治疗。记录三组患者在手术前(T0)、手术开始时(T1)、手术结束时(T2)、拔气管导管时(T3)以及拔管后10 min(T4)五个时间点的平均动脉压(MAP)和心率(HR)变化情况,同时对三组患者拔管时间、Price-Henry疼痛评分、谵妄发生情况进行记录和对比。结果:三组患者在T0、T1、T2时间点MAP、HR无显著变化,比较差异均无统计学意义(P0.05);与B、C组对比,A组患者的MAP、HR在T3、T4时刻明显升高,差异均有统计学意义(P0.05),而B、C组的MAP、HR变化情况比较差异无统计学意义(P0.05);A、B、C三组患者的拔管时间依次为(34±5)、(38±5)、(44±6)min;A组患者术后1、6、24、36 h的Price-Henry疼痛评分均明显高于B组和C组;A组患者谵妄的发生率高于B组,而B组患者谵妄的发生率高于C组,比较差异均有统计学意义(P0.05)。结论:不同剂量舒芬太尼复合丙泊酚静脉全麻技术可以有效降低术后谵妄的发生率,并且随着舒芬太尼剂量的不断增加,谵妄的发生率是逐渐降低的,因此值得在临床上推广应用。
[Abstract]:Objective: to analyze and explore the effect of different doses of sufentanil combined with propofol intravenous general anesthesia on the prevention of postoperative delirium. A total of 120 patients undergoing laparoscopic cholecystectomy under general anesthesia from January 2014 to January 2015 in our hospital were selected as study objects. According to the method of random drawing of lots, it was divided into three groups, 40 cases each, and was treated with different doses of sufentanil. The dosage of sufentanil in group A was 0.4 渭 g / kg. The dosage of sufentanil in group B was 0.5 渭 g / kg and the dosage of sufentanil in group C was 0.6 渭 g / kg. In addition, propofol 3 渭 g / ml was administered simultaneously during anesthesia in the three groups. The patients in the three groups were treated with T0 before operation, T1 at the beginning of operation, and T2 at the end of operation. The mean arterial pressure (MAPP) and heart rate (HRR) were measured at 5 time points after trachea extubation (T3) and 10 min (T4) after extubation. The extubation time was also measured in three groups. Price-Henry pain score and delirium incidence were recorded and compared. Results: there was no significant change in Price-Henry HR at T0 / T1 / T2 time point in the three groups. There was no significant difference between the two groups (P 0.05). Compared with group B C, MAPHR in group A was significantly higher than that in group A at T3 / T4, the difference was statistically significant (P 0.05), but MAP in group B C was significantly higher than that in group B (P < 0.05). There was no significant difference in HR changes (P 0.05). The extubation time of the three groups was 34 卤5, 38 卤5, 44 卤6 minutes. The Price-Henry pain scores of group A were significantly higher than those of group B and group C at 6 minutes and 24 minutes after operation. The incidence of delirium in group A was higher than that in group B, while the incidence of delirium in group B was higher than that in group C. Conclusion: different doses of sufentanil combined with propofol intravenous general anesthesia can effectively reduce the incidence of postoperative delirium. With the increasing of sufentanil dosage, the incidence of delirium is decreasing gradually, so it is worth popularizing in clinic.
【作者单位】：扬州市第一人民医院;
【分类号】：R614.2
【正文快照】： 术后并发症的发生会对患者的治疗效果和生活质量产生较大的影响,尤其是术后意识障碍。对于老年患者,其术后经常会出现认知功能障碍,而其中最常见的症状是谵妄[1]。谵妄属于急性脑器质性精神障碍,其临床特点主要表现为术后患者伴随明显的认知和意识功能障碍,同时伴发躯体功能紊

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