持续输注右美托咪定对老年骨科患者围手术期应激反应和恢复质量的影响

发布时间：2018-04-12 23:42

本文选题：右美托咪定 + 全身麻醉　；参考：《复旦大学》2014年博士论文

【摘要】：目的：观察在全身麻醉时持续输注右美托咪定对进行骨科手术的老年患者的机体应激反应和术后恢复质量的影响。方法：选择ASAI-Ⅱ级择期在全身麻醉下进行胸、腰椎手术或全髋关节置换术的老年患者(65-85岁)22例参加这项前瞻性、随机化、单盲及安慰剂对照的研究。所有患者被随机分为右美托咪定组(D组,n=11)和对照组(C组n=11),两组患者均进行标准化的麻醉诱导。D组患者在诱导后开始注射右美托咪定0.4μg/kg/hr,直至手术结束前3Omin停止；C组患者以0.9%氯化钠溶液代替右美托咪定,用法、用量与D组相同。观察记录患者在术前(T0)、划皮前(T1)、划皮后(T2)、气管拔管前(T3)和气管拔管后(T4)的平均动脉压(MAP)和心率(HR)。记录患者在进入和离开麻醉后监测治疗室(PACU)时的镇静程度(Ramsay评分)。记录患者在进入和离开PACU及术后第一天、术后第三天时的疼痛强度(VAS评分),并在术后第三天时完成评价术后恢复质量的QoR-40量表。检测患者术前、手术开始后1hr、进入PACU及术后第一天时的血糖、乳酸、胰岛素、皮质醇、游离脂肪酸浓度,检测术前和术后第一天时的血清肾上腺素和去甲肾上腺素浓度。结果：两组患者在一般资料和手术时间、麻醉时间、术中使用阿片类药物总量上没有统计学差异。右美托咪定组在T1、T2、T3时的MAP显著低于T0(P0.05),但两组间没有明显差异。拔管前后,右美托咪定组的MAP、HR无明显改变,而对照组中MAP(P0.05)和HR(P0.05)均显著上升。进入PACU时,右美托咪定组的Ramsay评分显著高于对照组(P0.05),到离开PACU时,两组之间Ramsay评分和VAS评分均没有差异。术后第一天时,右美托咪定组乳酸浓度(P0.05)和肾上腺素浓度(P0.01)低于术前并显著低于对照组,对照组乳酸浓度和去甲肾上腺素浓度显著高于术前(P0.05),两组患者在术后第三天时的QoR-40量表评分没有统计学差异。结论：老年患者进行全身麻醉下的骨科手术时,术中持续注射0.4μg/kg/hr右美托咪定可抑制拔管期间的血流动力学波动,对术后第一天时的应激反应有一定抑制作用,对于术后恢复质量没有显著改善。
[Abstract]:Aim: to observe the effect of continuous infusion of dexmetomidine during general anesthesia on stress response and postoperative recovery quality in elderly patients undergoing orthopaedic surgery.Methods: a prospective, randomized, single-blind and placebo-controlled study was conducted in 22 elderly patients aged 65 to 85 who underwent thoracic, lumbar or total hip replacement under general anesthesia.All patients were randomly divided into dexmetomidine group (D group) and control group (group C). Both groups were given standardized anesthesia induction. Group D began to inject dexmetomidine 0.4 渭 g / kg / kg 路h / h after induction, until the end of the operation, 3Omin stopped the treatment of group C.Patients were treated with 0.9% sodium chloride solution instead of dexmetomidine,The usage and dosage were the same as those in group D.The mean arterial pressure (MAPP) and heart rate (HRV) were recorded in patients with T0, T1, T2, T3 and T4) before and after extubation.The degree of sedation and Ramsay score were recorded when the patient entered and left the anaesthesia.The pain intensity and the score of PACU were recorded on the first day and the third day after operation, and the QoR-40 scale was completed on the third day after operation to evaluate the quality of postoperative recovery.Results: there was no significant difference in general data, operation time, anesthetic time and total amount of opioid use between the two groups.The MAP of right metomidine group was significantly lower than that of T0 group at T 1 and T 2 T 3, but there was no significant difference between the two groups.Before and after extubation, MAPHR of right metoimidine group did not change significantly, but MAPP 0.05 and HRP 0.05) increased significantly in control group.When entering PACU, the Ramsay score of the dexmetomidine group was significantly higher than that of the control group (P 0.05). There was no difference in Ramsay score and VAS score between the two groups at the time of leaving PACU.On the first day after operation, the concentrations of lactate and epinephrine in dexmetomidine group were lower than those before operation and significantly lower than those in control group.The concentration of lactate and norepinephrine in the control group was significantly higher than that in the preoperative group (P 0.05). There was no significant difference in the scores of QoR-40 scale between the two groups on the third day after operation.Conclusion: during orthopedic surgery under general anesthesia, continuous intraoperative injection of 0.4 渭 g/kg/hr dexmetidine can inhibit hemodynamic fluctuations during extubation and inhibit stress response on the first day after operation.There was no significant improvement in the quality of postoperative recovery.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R614

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