右美托咪定在冠心病患者俯卧位腰椎手术全麻中的应用

发布时间：2018-02-21 22:13

  本文关键词： 右美托咪定 冠心病 全身麻醉 腰椎手术 俯卧位　出处：《山东医药》2017年42期 　论文类型：期刊论文

【摘要】：目的观察右美托咪定对全麻俯卧位行腰椎手术的冠心病患者围术期血流动力学与麻醉并发症的影响。方法选择全麻俯卧位下行腰椎间盘切除术的冠心病患者80例,将患者随机分成观察组40例和对照组40例。观察组于麻醉诱导前静脉输注右美托咪定0.5μg/kg,输注时间15 min,继之以0.2μg/(kg·h)维持至术毕;对照组输注等量生理盐水。术中维持BIS值40~50。记录患者基础值(T_0)、麻醉诱导前即刻(T_1)、气管插管后即刻(T_2)、俯卧位后即刻(T_3)、俯卧位后30 min(T_4)、俯卧位后1 h(T_5)、手术结束(T_6)及平卧位后即刻(T_7)的收缩压(SBP)、舒张压(DBP)、心率(HR)、中心静脉压(CVP)、心输出量(CO)、每搏输出量(SV)和中心静脉血氧饱和度(SCVO2),术中心血管不良事件的发生情况和血管活性药物的使用情况,苏醒期和术后48 h内麻醉并发症的发生情况,统计患者的住院时间和术后28 d死亡情况。结果与对照组比较,观察组心动过缓的发生率增加,心肌缺血和心动过速的发生率降低;阿托品的平均每例用药次数和每次平均用药剂量增加,艾司洛尔的平均每例用药次数减少,去氧肾上腺素的每次平均用药剂量增加(P均0.05)。与T_0时比较,两组T_3时SBP、DBP、HR、CO、SV下降,T_2~T_7时HR下降,T_1,T_2,T_4~T_7时CVP增加(P均0.05)。与T_2时比较,对照组T_3时SBP、CVP、CO和SV下降,观察组T_3时CVP、CO和SV下降(P均0.05)。与T_3时比较,对照组T_4、T_6、T_7时SBP上升,T_4、T_6时DBP上升,T_4~T_7时CVP、CO和SV上升;观察组T_4~T_7时CVP、CO和SV上升(P均0.05);与对照组比较,观察组T_2~T_7时HR下降(P均0.05)。与对照组比较,观察组苏醒期躁动、刀口疼痛、心动过速和高血压的发生率降低(P均0.05),术后48 h内术后谵妄、刀口疼痛、恶心呕吐的发生率降低(P均0.05);两组术后28 d均无死亡病例。结论右美托咪定可增加冠心病患者全麻俯卧位期间血流动力学的稳定性,降低苏醒期和术后麻醉并发症的发生率,使苏醒过程更加平稳,更有利于患者术后的康复。
[Abstract]:Objective to observe the effect of dexmetomidine on perioperative hemodynamics and anesthetic complications in patients with coronary heart disease undergoing lumbar spine surgery in prone position of general anesthesia. Methods 80 patients with coronary heart disease underwent lumbar discectomy in prone position of general anesthesia were selected. The patients were randomly divided into the observation group (n = 40) and the control group (n = 40). Before anesthesia induction, dexmetidine 0.5 渭 g / kg was injected intravenously for 15 min, followed by 0.2 渭 g / kg 路h). The control group was infused with the same amount of normal saline. During the operation, the BIS value was maintained at 40: 50. The patient's basic value was recorded. Immediately before induction of anesthesia, T1 was added. Immediately after tracheal intubation, T 2 was added. Immediately after the intubation, T3 was added, 30 min after the prone position, 30 min after the prone position, 1 h after the prone position, 1 h after the supine position, 1 h after the operation, T6) and supine. Immediately after operation, SBP, DBP, HRD, CVP, COC, SVV) and SCVO2, the incidence of adverse cardiovascular events and the use of vasoactive drugs were observed in patients with acute acute respiratory syndrome (SBP), diastolic blood pressure (DBP), heart rate (HRV), central venous pressure (CVP), cardiac output (COG), and central venous oxygen saturation (SCVO2), and the incidence of adverse cardiovascular events and the use of vasoactive drugs. The incidence of anesthetic complications during the recovery period and 48 hours after operation, the duration of hospitalization and the death rate of 28 days after operation were counted. Results compared with the control group, the incidence of bradycardia in the observation group was higher than that in the control group. The incidence of myocardial ischemia and tachycardia decreased, the average number and dosage of atropine per case increased, and that of esmolol decreased. The average dose of norepinephrine increased by 0.05g / time. Compared with T _ (0), the CVP of two groups decreased at T _ (3) and T _ (3) and T _ (2) / T _ (7). Compared with T _ (2), the CVP increased at T _ (1) T _ (2) T _ (2) T _ (4) T _ (7) and decreased (P < 0.05) at T _ (3) in comparison with T _ (2), and decreased in control group (T _ 3) at T _ 3 and T _ (3), and decreased at T _ (2) T _ (7). In the observation group, the levels of CVPCO and SV in the observation group were 0.05% at T _ 3. Compared with T _ S _ 3, the SBP in the control group increased at T _ 4 / T _ 6 / T _ 7 / T _ 7 / T _ 4 / T _ 6, the CVP / CO and SV increased at T _ 4T _ 7 / T _ 7 in the observation group and 0.05 / d at T _ 4T _ 7 / T _ 7 respectively, respectively, and compared with those in the control group. Compared with the control group, the incidences of restlessness, knife edge pain, tachycardia and hypertension in the observation group were lower than those in the control group, and the incidence of postoperative delirium and knife edge pain within 48 hours after operation were lower in the observation group than in the control group. The incidence of nausea and vomiting decreased by 0.05 and there were no death cases in both groups on the 28th day after operation. Conclusion dexmetomidine can increase hemodynamic stability and decrease the incidence of anaesthesia complications in patients with coronary heart disease during general anesthesia prone position. To make the recovery process more stable, more conducive to postoperative rehabilitation of patients.
【作者单位】： 山东大学第二医院;
【分类号】：R614.2
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本文编号：1522991