右美托咪定对腹腔镜子宫全切患者围术期应激反应的影响

发布时间：2018-03-13 07:03

本文选题：右美托咪定　切入点：腹腔镜子宫全切　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨右美托咪定静脉持续输注对行妇科腹腔镜子宫全切手术患者血流动力学及应激反应的影响。方法择期行妇科腹腔镜子宫全切手术患者60例,ASA Ⅰ～Ⅱ级,随机分为两组：D组(右美托咪定组)和P组(对照组)。D组入室后以将0.6μg/kg负荷剂量的右美托咪定静脉泵注10min泵完,再以0.4μg/kg/h速度持续泵入右美至手术结束前30分钟,P组不泵入右美托咪定。两组患者麻醉诱导、维持均相同。其中麻醉维持丙泊酚按序贯法TCI血浆靶控输注,调整丙泊酚用量使BIS维持在45-50,手术中调节瑞芬太尼的用量维持BP波动在基础值20%范围左右。分别记录入室后5分钟病人安静时(T0)、插管后lmin(T1)、手术开始时(T2)、气腹形成后10min(T3)、解除气腹后5min(T4)、拔管后5min(T5)6个时间点的平均动脉压(MAP)和心率(HR)；检测T0、T1、T3、T4、T5五个时间点外周血皮质醇(cor)、肾上腺素(E)及去甲肾上腺素(NE)的浓度。结果1.两组患者年龄、体重指数、手术时间等一般情况比较差异均无统计学意义(P0.05)。 2.两组患者平均动脉压和心率在T0时点比较无统计学意义(P0.05),T1～5时点P组MAP明显升高,HR明显增快(P0.05)；D组MAP、HR变化不明显。两组比较差异有统计学意义(P0.05)。 3.两组患者外周血皮质醇浓度P组Tl、T3、T4、T5时点均高于基础值,D组在T3、T4、T5时点与T0相比明显降低(p0.05),两组比较差异有统计学意义(P0.05)。 4.两组患者外周血去甲肾上腺素浓度P组T1、T3、T4、T5时点均高于基础值,D组在T1、T3、T4、T5时点与T0点相比无明显变化。两组比较差异有统计学意义(P0.05)。 5.两组患者外周血肾上腺素浓度P组T1、T3、T4、T5时点均高于基础值,D组在T1、T3、T4、T5时点与T0点相比无明显变化。两组比较差异有统计学意义(P0.05)。结论1.静脉泵注右美托咪定可使患者围手术期血流动力学更加稳定。 2.静脉泵注右美托咪定能抑制肾上腺素、去甲肾上腺素、皮质醇的释放,减轻麻醉手术时患者的的应激反应。
[Abstract]:Objective to investigate the effect of continuous intravenous infusion of dexmetomidine on hemodynamics and stress response in patients undergoing gynecological laparoscopic hysterectomy. Methods A total of 60 patients undergoing elective laparoscopic hysterectomy were randomly divided into two groups: group D (group D) and group P (group P), who were injected with 0.6 渭 g / kg dexmetomidine intravenously for 10 minutes. At the speed of 0.4 渭 g / kg / h, the right metopropofol was continuously pumped into the right side until 30 minutes before the end of the operation. The anesthesia induction in both groups was the same as that in the control group, in which propofol was administered by sequential TCI plasma target control infusion. Adjusting the dosage of propofol to maintain BIS at 45-50 and adjusting the dosage of remifentanil to keep BP fluctuating in the range of 20% or so during operation. The patients were recorded at 5 minutes after entering the room during quiet time of T0, after intubation, after intubation, at the beginning of operation, T2 and pneumoperitoneum were formed. The mean arterial pressure (MAPP) and heart rate (HRT) were measured at 5 min after pneumoperitoneum, 5 min after extubation and 5 min after extubation, and the concentrations of cortisone, epinephrine (E) and norepinephrine (NE) in peripheral blood were detected at 5 time points. Results 1. There was no significant difference in age, body mass index and operation time between the two groups (P 0.05). 2. There was no significant difference in mean arterial pressure and heart rate between the two groups at T0. There was no significant difference in MAP and HR between the two groups at the time of T0. The difference between the two groups was statistically significant (P 0.05). 3. The concentration of cortisol in the peripheral blood of group P was significantly lower than that of group D at the time of T _ 3 T _ 4 T _ 5 and T _ 0, and there was a significant difference between the two groups (P 0.05), which was significantly higher than that in group D (P < 0.05), and the concentration of cortisol in group P was significantly lower than that in group D at T _ 3 / T _ (4) T _ (5) compared with T _ (0). 4. The concentration of norepinephrine in peripheral blood of group P was significantly higher than that of group D at T _ (1) T _ (3) T _ (3) T _ (4) T _ (5) and T _ (0). The difference between the two groups was statistically significant (P < 0.05), and there was no significant difference between the two groups at T _ (1) T _ (3) T _ (4) T _ (5) and T _ (0). 5. The concentration of epinephrine in the peripheral blood of group P was significantly higher than that of group D at T _ (1) T _ (3) T _ (3) T _ (4) T _ (5) and T _ (0). The difference between the two groups was statistically significant (P < 0.05), and there was no significant difference between the two groups at T _ (1) T _ (3) and T _ (4) T _ (5). Intravenous injection of dexmetidine can make hemodynamics more stable in perioperative period. 2. 2. Intravenous injection of dexmetidine inhibited the release of epinephrine, norepinephrine and cortisol, and alleviated the stress response of patients undergoing anesthesia.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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