右美托咪定静脉麻醉对高血压病人恢复期的影响

发布时间：2018-06-05 01:12

本文选题：右美托咪定 + 高血压　；参考：《吉林大学》2014年硕士论文

【摘要】：背景：高血压是多种心、脑血管疾病的重要病因和危险因素，影响重要脏器，如心、脑、肾的结构与功能，，根据其分类可将高血压分为原发性高血压和继发性高血压两大类，通常所说的高血压是指原发性高血压（primary hypertension），其是指以血压升高为主要临床表现伴或不伴有多种心血管危险因素的综合征。患有高血压的患者在全身麻醉恢复期气管拔管阶段易发生血压剧烈波动，从而导致围手术期心脑血管意外的发生，增加麻醉的相关风险。因此，对于高血压的患者来说，如果想要保证患者的生病安全，必须维持麻醉苏醒期间血流动力学的相对稳定。右美托咪定(dexmedetomidine，DEX)的出现给患者带来了福音，其是一种新型的α2肾上腺素受体激动剂，具有高度特异性、高选择性；具有催眠、抗焦虑、镇静、抗交感、镇痛效应，同时更因其无呼吸抑制、稳定的血流动力学以及其独特的可唤醒效应，被广泛应用于临床。目的：观察右美托咪定应用于静脉麻醉对高血压病人恢复期的影响并指导临床用药。方法：选择高血压I-II级，拟在全麻下择期手术病人60例，随机分为二组：丙泊酚组（C组）和右美托咪定组（D）组，每组各30例。C组和D组均吸入七氟醚1.8%-2%，同时C组采用微量泵输入丙泊酚2～3mg/（kg·h）和瑞芬太尼2～4μg/（kg·h），D组采用微量泵输入右美托咪定和瑞芬太尼2～4μg/（kg·h），右美托咪定以1μg/kg输注10min后用0.2～0.7μg/kg/h持续输注，两组患者均在手术缝皮结束时停药，监测手术结束至拔管后10min的血流动力学指标，镇痛评分及躁动情况。结果:两组患者的一般资料无显著性差异。接受DxM治疗的患者在全麻恢复期血流动力学稳定、镇痛良好和无躁动发生。结论： 1、右美托咪定可以应用于静脉麻醉。 2、右美托咪定有利于维持血流动力学的稳定，减少心脑血管事件的发生。
[Abstract]:Background: hypertension is an important etiology and risk factor for many kinds of heart and cerebrovascular diseases. It affects the structure and function of important organs, such as heart, brain and kidney. According to its classification, hypertension can be divided into two categories: essential hypertension and secondary hypertension. Hypertension is usually referred to as primary hypertensionation of essential hypertension, which refers to syndrome with or without multiple cardiovascular risk factors with elevated blood pressure as the main clinical manifestation. Patients with hypertension are prone to severe fluctuation of blood pressure in the stage of tracheal extubation during the convalescent stage of general anesthesia, which leads to the occurrence of perioperative cardio-cerebrovascular accidents and increases the risk of anesthesia. Therefore, for patients with hypertension, hemodynamic stability during anaesthesia recovery must be maintained if the patient is to be safe from illness. The advent of dexmemedetomine (DEX) is a new type of 伪 2-adrenergic agonist with high specificity and selectivity, hypnosis, anti-anxiety, sedation, anti-sympathetic and analgesic effects. At the same time, it is widely used in clinic because of its no respiratory inhibition, stable hemodynamics and its unique arousal effect. Aim: to observe the effect of dexmetomidine on the recovery of hypertensive patients and to guide the clinical use of dexmetomidine. Methods: sixty patients with I-II grade hypertension were randomly divided into two groups: propofol group (group C) and dexmetomidine group (group D). Each group (n = 30) and group D (n = 30) were inhaled with sevoflurane 1.8-2, and group C received intravenous infusion of propofol (2~3mg/(kg h) and remifentanil (2 渭 g/(kg / h) respectively. Dextromidine and remifentanil (24 渭 g/(kg / h) were injected continuously with 10min at 1 渭 g/kg. The hemodynamic indexes, analgesic scores and restlessness of 10min were monitored at the end of suture skin operation in both groups. Results: there was no significant difference in general data between the two groups. Patients treated with DxM had stable hemodynamics, good analgesia and no restlessness during general anesthesia recovery. Conclusion: 1. Dexmetomidine can be used in intravenous anesthesia. 2, dexmetomidine is beneficial to maintain hemodynamic stability and reduce the occurrence of cardiovascular and cerebrovascular events.
【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】：R614

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