右美托咪定对妇科腔镜手术中应激反应的影响
发布时间：2018-03-05 10:20
本文选题：右美托咪定 切入点：气腹 出处：《苏州大学》2014年硕士论文 论文类型：学位论文
【摘要】：目的：观察使用右美托咪定（dexmedetomidine，Dex）在妇科腹腔镜手术中对机体应激反应的影响。 方法：选择40例择期妇科腔镜手术患者，ASAI～II级，年龄20～65岁，体重45～70kg。患者随机分为两组,每组20例(n=20)。D组(右美托咪定负荷组)在麻醉诱导前给予右美托咪定负荷量0.8μg.kg-1静脉泵注10min，然后以咪达唑仑、芬太尼、异丙酚、顺式阿曲库铵进行麻醉诱导；C组（对照组）在诱导前给予等容量的生理盐水泵注,麻醉诱导同D组；两组患者术中给予芬太尼、丙泊酚、顺式阿曲库铵、七氟醚维持麻醉。记录两组患者血流动力学及麻醉药的用量，，并在麻醉诱导前(T1)、气管插管前(T2)、手术开始时(T3)、气腹15min(T4)、气腹30min(T5)、手术后24h(T6)时检测患者血中促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）、皮质醇（cortisl，Cor）、儿茶酚胺（catecholamin，CA）、抗利尿激素(antidiuretichormone，ADH)以及醛固酮(aldosterone, ALD)的含量。其中ACTH及Cor采用电化学发光免疫分析法、CA以及ADH采用ELISA法、ALD采用γ-放射免疫法。 结果： 与D组相比， C组患者T1、 T2、 T6时间点的血ACTH、Cor、CA、ADH、ALD无明显差异（P㧐0.05）；而T3、T4、T5时间点的血ACTH、Cor、CA、ADH、ALD显著高于D组，二者差异有统计学意义（P＜0.05）。与D组相比，C组患者T1、T2、T6时间点的心率、血压变化无明显差异（P㧐0.05），而T3、T4、T5时间点的C组患者心率、血压变化明显增大，二者差异有统计学意义（P＜0.05）。 结论：妇科腔镜手术中应用Dex能明显减少应激激素血ACTH、Cor、CA、ADH、ALD的释放，并能有效稳定血流动力学,使患者术中生命体征更平稳。Dex是较好的全身麻醉辅助用药。
[Abstract]:Objective: To observe the effect of dexmedetomidine (Dex) on the stress response of the body during gynecologic laparoscopy.
Methods: 40 cases of patients undergoing gynecological laparoscopic surgery patients, ASAI ~ II, age 20~65 years old, weighing 45 ~ 70kg. were randomly divided into two groups, 20 cases in each group (n=20) and.D group (dexmedetomidine loading group) received dexmedetomidine loading 0.8 g.kg-1 intravenous infusion of 10min in induction of anesthesia before then, with midazolam, fentanyl, propofol and cisatracurium anesthesia; group C (control group) was given before the induction of saline infusion volume, induction of anesthesia with D group; the two groups of patients treated with fentanyl, propofol and cisatracurium, sevoflurane record two groups of patients with anesthesia. The hemodynamics and anesthetic dosage, and before induction of anesthesia (T1), before intubation (T2), at the beginning of the operation (T3), 15min pneumoperitoneum (T4), 30min pneumoperitoneum (T5), 24h after operation (T6) ACTH test in patients with (adrenocorticotropic hormone, ACTH), Cortisl (Cor), catecholamine (catecholamin, CA), antidiuretic hormone (antidiuretichormone, ADH) and aldosterone (aldosterone, ALD) content. ACTH and Cor were analyzed by electrochemiluminescent immunoassay, CA and Cor were used by gamma method, and gamma ray radioimmunoassay was used.
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