右美托咪定与艾司洛尔用于正颌手术控制性降压的比较研究

发布时间：2018-03-08 08:31

本文选题：艾司洛尔　切入点：右美托咪定　出处：《上海交通大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景：控制低血压是一种常用来减少术中失血,改善手术视野,减少手术时间,从而减少输血的技术。对于身体健康的患者将MAP降低至50-60mmHg，通常是可以耐受的。目的：这个双盲、随机、对照研究的目的是比较右美托咪定（一种短效的中枢性α2受体激动剂）与艾司洛尔（一种短效的β受体阻滞剂）在正颌外科手术中，包括LefortI型截骨术、下颌升支截骨术等，进行控制性降压，控制术中出血的作用，，以帮助麻醉医师及外科医师在术前对术中输血补液及手术等情况做好充分的准备。方法：将90名17-36岁，ASA分级I-II级的患者随机分为右美组、艾司洛尔组及硝酸甘油组（对照），所有患者全部接受静吸复合全身麻醉，术中进行控制性降压。记录HR、MAP、控制性降压时间、达到目标血压时间、术中失血量、瑞芬太尼的用量、术后苏醒时间及术中术野质量评定。结果：3组术中出血量无显著差异，瑞芬太尼的用量右美组明显少于艾司洛尔组，而艾司洛尔组在恢复时间上比右美组相对较短。结论：右美托咪定与艾司洛尔均可提良好的控制性降压效果，减少术中失血，而右美托咪定与艾司洛尔相比显著延长了术后苏醒时间。
[Abstract]:Background: hypotension control is a technique commonly used to reduce intraoperative blood loss, improve operative visual field, and reduce operative time, thereby reducing blood transfusion. For healthy patients, lowering MAP to 50-60 mm Hg is generally tolerable. Objective: this double-blind, randomized, controlled study was designed to compare dexmetomidine (a short-acting central 伪 2-receptor agonist) with esmolol (a short-acting beta blocker) in orthognathic surgery. Including LefortI osteotomy, mandibular ramus osteotomy and so on, the effect of controlled hypotension and bleeding control was carried out to help anesthesiologists and surgeons prepare well for transfusion and resuscitation before operation. Methods: 90 patients aged 17-36 years with ASA grade I-II were randomly divided into right group, esmolol group and nitroglycerin group (control group, all patients received intravenous inhalation combined with general anesthesia). Control hypotension was performed during the operation, HRP MAP, controlled hypotension time, time to reach target blood pressure, blood loss during operation, dosage of remifentanil, postoperative recovery time and quality evaluation of operative field were recorded. Results there was no significant difference in the volume of intraoperative bleeding among the three groups, and the dosage of remifentanil in the right group was significantly lower than that in the esmolol group. The recovery time of esmolol group was shorter than that of right American group. Conclusion: both dexmetomidine and esmolol have good controlled hypotension effect and reduce intraoperative blood loss. Dexmetomidine significantly prolonged postoperative recovery time compared with esmolol.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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