芬太尼两种不同给药方案对预防肺癌患者术后躁动影响的比较

发布时间：2018-03-10 20:39

本文选题：芬太尼　切入点：肺癌　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：观察肺癌患者行开胸手术时同等剂量芬太尼的两种给药方案对患者术中血流动力学及其全麻苏醒期躁动的影响。方法：选择自2012年8月至2013年12月在我院行肺癌手术的ASA II-III级、年龄50-70岁、体重60-80kg的患者68例,随机分为A组(超前阵痛组)和B组（术中追加组）,每组34例，两组在性别、年龄、体重、ASA分级等方面无显著统计学差异，资料具有可比性。患者入室后常规监测血压（BP）、心电图（ECG）、心率（HR）、血氧饱和度（SpO2）、中心静脉压（CVP）、脑电双频指数（BIS）等。两组均静脉注射咪达唑仑0.08mg/kg、顺苯磺酸阿曲库铵0.15mg/kg、依托咪酯脂肪乳0.3mg/kg、枸橼酸芬太尼进行全麻诱导，诱导时除芬太尼其余药物剂量相同。输注顺苯磺酸阿曲库铵3-5min后插入气管导管,接呼吸机行机械通气，术中以顺式阿曲库铵0.04-0.08mg/kg间断静脉推注，根据生命体征以丙泊酚4-12mg/(kg.h)、瑞芬太尼0.25μg/(kg.min)泵注维持麻醉。A组诱导时给予芬太尼4μg/kg，手术开始前5min给予芬太尼3μg/kg。而B组诱导时给予芬太尼3μg/kg，手术开始前5min给予芬太尼2μg/kg，随后每隔一小时给予1μg/kg。最终两组患者给予的芬太尼总量均为7μg/kg。监测并记录两组患者分别在诱导前(T0)、诱导后(T1)、插管后(T2)、手术开始后(T3)、手术开始后1小时(T4)、手术结束时(T5)、拔管时(T6)、拔管后15分钟时(T7)测得的收缩压(SBP)、平均动脉压(MAP)、脉搏(HR)。监测苏醒指标、观察拔管后副反应、进行拔管后VAS疼痛评分及Riker躁动-镇静评分。结果：（1）两组病人的一般情况，诱导前(T0)收缩压、平均动脉压、脉搏、脑电双频指数均无显著性差异（P0.05)。（2）术中追加组在T2、T3两时间点血流动力学变化较超前镇痛组明显，有显著性差异（P0.05）。（3）两组患者呼吸恢复时间、睁眼时间、准确完成指令时间和拔管时间等苏醒指标间有显著性差异（P0.05）。(4)两组拔管后躁动和嗜睡患者间有显著性差异（P0.05）。（5）两组患者相比较，拔管后5min、10min、15min时无疼痛的患者间比较有显著性差异（P0.05）。拔管后5min、10min时自述有能忍受的轻微疼痛的患者间比较有显著性差异（P0.05）。拔管后15min时自述疼痛影响睡眠的患者间比较有显著性差异（P0.05）。（6）拔管后，两组平静合作和非常躁动的患者间比较有显著性差异（P0.05）。结论：超前镇痛组患者较术中追加组患者血流动力学更加稳定，镇痛效果佳，，且苏醒期躁动样本数少，苏醒迅速平稳，麻醉并发症少，可以作为肺癌开胸手术全身麻醉的一种有价值的方法。
[Abstract]:Aim: to observe the effect of two same dosage of fentanyl on hemodynamics and restlessness during general anesthesia in patients with lung cancer. Methods: from August 2012 to December 2013, 68 patients with ASA II-III, aged 50-70 years old and weighing 60-80kg, who underwent lung cancer surgery in our hospital from August 2012 to December 2013 were randomly divided into two groups: group A (preemptive labor pain group) and group B (intraoperative supplementation group, 34 cases in each group). There was no significant difference in age, weight and ASA grading, and the data were comparable. After entering the room, the patients were routinely monitored for blood pressure BPU, electrocardiogram (ECG), ECGG, HRT, SPO _ 2, CVP, BIS.Meidazolam 0.08 mg / kg, atracurium cis-benzenesulfonate 0.15 mg / kg, mididazolam 0.3mg / kg, probiotic fat milk 0.3 mg / kg, respectively. Fentanyl citrate was induced by general anesthesia. After 3-5 minutes of infusion of atracurium sulfonic acid, the trachea catheter was inserted into the trachea, and mechanical ventilation was performed by ventilator. The intravenous injection of cis-atracurium 0.04-0.08 mg / kg was performed during induction. According to vital signs, propofol 4-12 mg / kg 路kg 路h 路h, remifentanil 0.25 渭 g / kg 路min) was administered to group A with 4 渭 g / kg fentanyl during induction and 3 渭 g / kg 路kg ~ (-1) of fentanyl 5 minutes before operation. In group B, fentanyl 3 渭 g / kg was given 5 minutes before operation, and 2 渭 g / kg of fentanyl was given 5 minutes before operation. The total amount of fentanyl given to each group was 7 渭 g / kg. after induction, T0, T1, T2, T3, T4 and T4 were monitored and recorded before induction, after induction, after intubation, and 1 hour after operation, respectively. Systolic blood pressure (SBP), mean arterial pressure (MAPP), pulse time (HRP) and recovery index were monitored. Side effects after extubation were observed, VAS pain score and Riker restlessness-sedation score after extubation were performed. Results there was no significant difference in systolic blood pressure, mean arterial pressure, pulse and bispectral index of EEG between the two groups (P < 0.01). The hemodynamic changes in the supplementary group at T _ 2 / T _ 3 were significantly higher than those in the preemptive analgesia group. There was significant difference in recovery time of respiration, time of eye opening, time of accurate completion of instruction and time of extubation between the two groups (P 0.05. 05. 4) there was significant difference between the two groups after extubation in restlessness and sleepiness (P 0. 05. 05. 5) the difference between the two groups was significant (P < 0. 05. 5), and there was no significant difference between the two groups (P < 0. 05. 5) after extubation, there was a significant difference between the two groups of patients with restlessness and somnolence after extubation. There was significant difference between the patients who had no pain at 5 min or 10 min after extubation (P 0.05). There was a significant difference between the patients who reported that they could endure mild pain at 5 min or 10 min after extubation. There was a significant difference between the patients who reported that the pain affected sleep 15 min after extubation. There was a significant difference between the patients who reported that the pain affected their sleep 15 minutes after extubation. There were significant differences between the patients who reported that the pain affected their sleep 15 minutes after the extubation of the tube. There was significant difference after extubation. There was a significant difference between the two groups in calm cooperation and very restless patients (P 0.05). Conclusion: the patients in the preemptive analgesia group are more stable in hemodynamics than those in the supplementary group during the operation. The analgesic effect is better than that in the preemptive analgesia group. It can be used as a valuable method of general anesthesia for lung cancer open chest surgery.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R734.2

【参考文献】