右美托咪啶与氟芬合剂在功能区胶质瘤切除术术中唤醒麻醉效果的比较

发布时间：2018-05-12 21:29

本文选题：唤醒麻醉 + 氟芬合剂　；参考：《山东大学》2017年硕士论文

【摘要】：目的比较右美托咪啶与氟芬合剂在功能区脑胶质瘤切除术术中唤醒期的效果,为术中唤醒麻醉药物选择提供科学依据。方法选择40例拟行功能区脑胶质瘤切除联合术中唤醒术患者,术中需唤醒以确定大脑皮层功能区位置,随机分为右美托咪啶组(D组)与氟芬合剂组(F组),每组20例。两组均以丙泊酚,瑞芬太尼全麻诱导,行喉罩控制通气。在进行电生理监测前15 min停止丙泊酚、瑞芬太尼输注,F组以芬太尼100ug,氟哌利多5mg负荷剂量泵注30min,之后以芬太尼100ug/h,氟哌利多5mg/h持续泵注维持;D组静脉注射右美托咪啶负荷剂量0.5ug/kg,之后以右美托咪啶0.3ug/kg/h-0.5ug/kg/h持续输注维持。待患者自主呼吸恢复以后,拔出喉罩。肿瘤切除后,再次行麻醉诱导置入喉罩,持续输注丙泊酚,瑞芬太尼,直至手术结束。本实验主要观察指标为唤醒期警觉/镇静评分、疼痛数字评分、脑功能区定位时态评分,唤醒时间,观察患者术中呼吸抑制、恶心呕吐、躁动、寒战等不良反应发生情况。术中生命体征观察的时间点为:基础值(T0)、停止输注丙泊酚即刻(T1)、唤醒即刻(T2)、唤醒后5min(T3)、唤醒后10min(T4)、唤醒后15min(T5)、唤醒后30min(T6)、唤醒后60min(T7)。记录各个时点的MAP、HR、SpO2。采用SPSS19.0软件进行数据处理,计量资料以均数士标准差形式表示,采取两独立样本t检验;计数资料以百分比表示,使用卡方检验;术中各评分结果采用秩和检验,P0.05时差异有统计学意义。结果1.两组患者性别、年龄、身高、体重、体重指数差异均无统计学意义(P0.05)。2.右美托咪啶组唤醒期血压,心率,唤醒时间显著低于氟芬合剂组(P0.05)。3.警觉/镇静评分,疼痛数字评分,脑功能区定位时态评分得分差异无统计学意义(P0.05)。4.右美托咪啶组3例患者出现恶心,氟芬合剂组1例患者出现呼吸抑制,不良事件发生率差异无统计学意义(P0.05),两组患者均未发生躁动、寒战。结论1.右美托咪啶与氟芬合剂均能成功用于功能区脑胶质瘤切除术术中唤醒麻醉。2.右美托咪啶组唤醒时间短,术中唤醒期间血流动力学更稳定。
[Abstract]:Objective to compare the arousal effect of dexmetidine and flufen mixture in functional area glioma resection, and to provide scientific basis for the choice of anesthetic drugs. Methods Forty patients with functional glioma resection combined with intraoperative arousal were randomly divided into group D (group D) and group F (n = 20 in each group). Both groups were induced by general anesthesia with propofol and remifentanil and were treated with laryngeal mask controlled ventilation. Propofol was stopped 15 min before electrophysiological monitoring. Remifentanil was injected with fentanyl 100ug, droperidol 5mg loading dose pump for 30 mins, then fentanyl 100ugrhh. droperidol 5mg/h continued to be injected intravenously with dexmetimetidine at a loading dose of 0.5 g / kg, and then was maintained with dexmetidine 0.3ug/kg/h-0.5ug/kg/h. After the patient regains his own breathing, pull out the laryngeal mask. After tumor resection, the larynx mask was induced again by anesthesia and continued infusion of propofol and remifentanil until the end of the operation. The main indexes of this experiment were arousal alarm / sedation score, pain number score, brain functional area localization tense score, arousal time, and observe the occurrence of adverse reactions during operation, such as respiratory depression, nausea and vomiting, restlessness, shivering and so on. The observation time points of vital signs during the operation were as follows: the basic value was T _ 0, the infusion of propofol was stopped immediately, the T _ (2) T _ (2) was awakened immediately, the T _ (3) was activated at 5 min, the T _ (4) was 10 min after arousal, the T _ (5) was 15 min after arousal, the time was 30 min after arousal, and 60 min T _ (7) after arousal. MAPHR-SPO _ 2. SPSS19.0 software was used to process the data, the measurement data was expressed in the form of standard deviation of mean number, and two independent samples t-test were adopted, the counting data was expressed as percentage and chi-square test was used. There was a significant difference in the results of intraoperative scoring with rank sum test (P 0.05). Result 1. The gender, age, height and body mass index of the two groups were not significantly different (P < 0.05). The blood pressure, heart rate and arousal time of dexmetidine group were significantly lower than that of fluphene mixture group (P 0.05N. 3). There was no significant difference in the scores of alertness / sedation score, pain number score and brain functional area localization tense score (P 0.05). 4. There were 3 cases of nausea in dexmetidine group and 1 case of respiratory depression in flufen mixture group. There was no significant difference in the incidence of adverse events between the two groups (P 0.05). There was no restlessness and shivering in both groups. Conclusion 1. Both dexmetidine and flufenac can be successfully used in arousal anesthesia. 2. The wakeup time of dexmetidine group was shorter and hemodynamics was more stable during intraoperative arousal.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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