不同麻醉方式对老年胃癌手术患者血浆褪黑素浓度影响及其与苏醒期躁动的关系

发布时间：2018-02-15 14:52

本文关键词： 苏醒期躁动褪黑素老年胃癌手术　出处：《安徽医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：比较气管内全麻或硬膜外复合全麻这两种不同麻醉方式对老年胃癌手术患者血浆褪黑素浓度影响及其与苏醒期躁动关系。方法：50例老年胃癌患者随机均分成两组，T组为气管内全麻组，ET组为硬膜外复合全麻组。ET组患者选择T8-9间隙给予硬膜外穿刺，，操作成功后分次给予1%利多卡因+0.25%罗哌卡因混合液，总量约10-15ml，于硬膜外停止给药后15min测定阻滞平面再行全麻诱导。两组患者全麻诱导依次给予咪达唑仑0.04mg/kg、依托咪酯0.2-0.3mg/kg、芬太尼3-4μg/kg、罗库溴铵0.6-0.8mg/kg，待BIS值达到40行气管插管，后连接麻醉机行机械通气，术中维持PetCO2为35-45mmHg，BIS值在40-50。术中静脉持续泵人丙泊酚2-6mg/kg·h，瑞芬太尼6-10μg/kg·h维持麻醉，ET组患者每隔1h左右硬膜外给药，术中按需静注顺阿曲库铵0.05-0.1mg/kg，手术期间维持患者血压在基础血压的正负20%，术中若出现血压过高或过低，适当给予血管活性药物（尼卡地平或麻黄素），若心率＜50次/分，持续1min未缓解者静注阿托品0.5mg治疗。手术结束后，待患者自主呼吸恢复，SpO2维持在95%以上，意识清醒，拔出气管内导管。ET组患者术毕拔除硬膜外导管，两组患者术毕清醒拔管后均接电子镇痛泵，持续至术后2天。麻醉恢复期对患者进行躁动评分并记录，采集麻醉前（T0）、手术结束（T1）2个时点的中心静脉血测定血浆褪黑素浓度。本实验为排除手术过程中光线对褪黑素分泌的抑制作用,均在诱导麻醉后对患者头部施以包裹处理,术前均以利多卡因乳膏润滑导尿管为减轻术后因导尿管刺激引起病人的术后烦躁。结果:与T组比较,ET组患者术后躁动评分明显降低（P0.01）,术毕患者血浆褪黑素浓度明显增高（P0.01）;在T或ET这两种不同麻醉方式下，患者苏醒期躁动评分与术毕褪黑素浓度有相关（r=-0.429，P0.05）。结论：老年胃癌患者在ET麻醉方式下，可减少苏醒期躁动的发生，且与术毕血浆褪黑素浓度呈负相关。
[Abstract]:Aim: to compare the effect of general anesthesia or epidural general anesthesia on plasma melatonin concentration in elderly patients with gastric cancer and its relationship with restlessness during recovery. Methods 50 elderly patients with gastric cancer were randomly divided into two groups: group T: endotracheal general anesthesia group (group et), group et: combined epidural general anesthesia group. Group et selected the T8-9 space for epidural puncture. After successful operation, 1% lidocaine and 0.25% ropivacaine were given separately. The total amount was about 10-15 ml. After the epidural administration was stopped, the block level was measured and induced by general anesthesia. The patients in the two groups were given midazolam 0.04 mg / kg, etomidate 0.2-0.3 mg / kg, fentanyl 3-4 渭 g / kg, rocuronium 0.6-0.8 mg / kg, and the BIS was 40 lines tracheal intubation. The maintenance PetCO2 was 35-45 mmHg BIS between 40 and 50. Intravenous infusion of propofol 2-6 mg / kg 路h and remifentanil 6-10 渭 g / kg 路h were administered every 1 hour or so. Intraoperative intravenous injection of cisatracurium 0.05-0.1 mg / kg was performed during the operation to maintain the positive or negative basic blood pressure of the patient. If the blood pressure was too high or too low during the operation, appropriate vasoactive drugs (nicardipine or ephedrine, heart rate < 50 / min) were given. After the operation, SPO _ 2 was maintained above 95%, conscious, and the patients in the et group were removed the epidural catheter after the operation, and the patients in the endotracheal catheter group were removed after the operation, and the patients in the control group were treated with atropine 0.5 mg. The patients in both groups were treated with electronic analgesia pump after the operation. The restlessness score was recorded during the recovery period of anesthesia. The concentration of plasma melatonin was measured in central venous blood at two time points before anesthesia and at the end of operation. In order to exclude the inhibitory effect of light on the secretion of melatonin during operation, the patients' head was treated with encapsulation after induction of anesthesia. Results: compared with group T, the postoperative restlessness score of patients in et group was significantly lower than that in group T, and the plasma melatonin concentration in patients at the end of operation was significantly lower than that in group T. It was significantly higher than that of P0.01T or et under two different anesthetic methods, The restlessness score was correlated with melatonin concentration at the end of operation. Conclusion: the elderly patients with gastric cancer can reduce restlessness in the recovery period under et anesthesia, and have a negative correlation with the plasma melatonin concentration at the end of operation.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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