耳穴埋针对TCI诱导时脑电双频指数和异丙酚—瑞芬太尼血浆效应室浓度的影响

发布时间：2018-02-12 04:36

本文关键词： 耳穴埋针 TCI 丙泊酚瑞芬太尼 BIS　出处：《福建中医药大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：本研究旨在评估耳穴埋针结合靶控输注技术在腹股沟疝手术的麻醉中对丙泊酚-瑞芬太尼静脉麻醉的辅助作用。方法：选取普外科腹外疝50例择期手术患者,ASA I或Ⅱ级,随机分为耳针组和对照组各25例。对照组：丙泊酚+瑞芬太尼；耳针组：对照组基础上加耳穴埋针病侧腹股沟穴、肝脏、皮质下、神门穴。患者入室后连接监测仪,进行ECG、血压、脉搏血氧饱和度(SpO2)监测,同时连续动态监测脑电双频谱指数(BIS)。耳针组,用对压法相对压迫贴于耳穴的胶布,每穴按压10下,诱导时间为30min。后行静脉全麻,耳穴埋针持续至术毕。靶控输注丙泊酚,以血浆靶浓度1.5ug/L为起点,到达预期血浆靶浓度后每30秒递增0.3ug/L,直至患者意识消失。将丙泊酚的靶控血药浓度值调整为当时仪器显示的效应室浓度值,并保持此浓度不变。然后靶控输注瑞芬太尼,以瑞芬太尼血浆浓度2.0ug/L为起点,到达预期血浆靶浓度后每30秒递增0.3ug/L。直至患者对(压眶反射)疼痛刺激无体动反应,记录两组病人意识、疼痛消失时血药及效应室浓度、围术期血流动力学变化及脑电双频指数的变化。结果： 1.两组病人性别、年龄、体重、身高差异均无统计学意义 2.与对照组相比,耳针组诱导过程中血流动力学更平稳(p0.05),拔管时对照组心率和血压较高(p0.05) 3.意识消失时,耳针组丙泊酚血浆、效应室浓度明显低于对照组,差别有统计学意义(p0.05) 4.疼痛反应消失时,耳针组瑞芬太尼血浆、效应室浓度明显低于对照组,差别有统计学意义(p0.05) 5.耳穴埋针后,耳针组与对照组BIS值分别为87±9、96±1,其差别有统计学意义p0.05),说明BIS与耳穴埋针具有良好的相关性。 6.与对照组相比,耳针组的瑞芬太尼在手术过程中用药总剂量明显降低,对照组在手术过程中丙泊酚用药总剂量变化不明显。结论：1.当意识和疼痛消失时,耳针减少了TCI诱导期间丙泊酚瑞芬太尼血浆效应室浓度。 2.围麻醉期间耳针埋针减少了麻醉全程丙泊酚／瑞芬太尼的总用量。 3.全身麻醉期间,结合血流动力学变化,BIS和病例的麻醉深度相关性良好。
[Abstract]:Objective: to evaluate the auxiliary effect of auricular acupuncture combined with target-controlled infusion on propofol-remifentanil intravenous anesthesia in inguinal hernia surgery. Methods: fifty patients with abdominal external hernia in general surgery were randomly divided into auricular acupuncture group (n = 25) and control group (n = 25). The control group: propofol remifentanil; Liver, subcortical, Shenmen points. The patients were monitored by ECG, blood pressure, pulse oxygen saturation (SPO _ 2) after entering the room. At the same time, the bispectral index of electroencephalogram (BIS) was continuously monitored. In the auricular acupuncture group, the pressure method was used to compress the adhesive cloth attached to the auricular points. The induction time was 30 mins for 10 times per acupoint, followed by intravenous general anesthesia, auricular acupoint embedding needle continued until the end of operation. Target-controlled infusion of propofol, starting with the plasma target concentration of 1.5ug-1 / L, increased by 0.3 ugr / L every 30 seconds after reaching the expected plasma target concentration, until the patient's consciousness disappeared. The target controlled plasma concentration of propofol was adjusted to the effect chamber concentration shown by the instrument at that time. Then the target controlled infusion of remifentanil, starting with remifentanil plasma concentration 2.0ugp / L, increased by 0.3 ugr / L every 30 seconds after the expected plasma concentration was reached, until the patient had no physical response to the pain of (orbital baroreflex). The consciousness, the concentration of blood drug and effector ventricle, the hemodynamic changes and the change of bispectral index of EEG were recorded in the two groups when the pain disappeared. Results:. 1. There was no significant difference in sex, age, weight and height between the two groups. 2.Compared with the control group, the hemodynamics of the auricular acupuncture group was more stable than that of the control group, and the heart rate and blood pressure of the control group were higher than that of the control group during the extubation. 3.When consciousness disappeared, the plasma concentration of propofol in auricular acupuncture group was significantly lower than that in control group (P 0.05). 4.When the pain reaction disappeared, the concentration of remifentanil plasma and effector chamber in auricular acupuncture group was significantly lower than that in control group (P 0.05). 5. The BIS values of auricular acupuncture group and control group were 87 卤90.96 卤1, respectively. The difference was statistically significant (p0.05), which indicated that BIS had a good correlation with auricular acupuncture. 6. Compared with the control group, the total dose of remifentanil in the auricular acupuncture group decreased significantly during the operation, while the total dose of propofol did not change significantly in the control group. Conclusion 1. When consciousness and pain disappear, ear acupuncture reduces plasma effector ventricular concentration of propofol remifentanil during TCI induction. 2. The total dosage of propofol / remifentanil was reduced by auricular acupuncture during perianaesthesia. 3. During general anesthesia, there was a good correlation between BIS and depth of anesthesia combined with hemodynamic changes.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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