术中应用右美托咪定对甲状腺手术患者呛咳反应及术后恢复的影响

发布时间：2018-06-08 16:44

本文选题：右美托咪定 + 甲状腺手术　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的探讨右美托咪定(Dexmedetomidine,DEX)对甲状腺手术患者全麻恢复期间呛咳反应及术后恢复情况的影响。方法纳入2015年12月至2016年6月在我院行甲状腺肿瘤手术的患者为研究对象,选择年龄18~64岁,BMI 18~30kg/m~2,ASA分级Ⅲ级以下的患者118例,随机分为两组:右美托咪定组和生理盐水组,前者在手术开始时持续静脉泵注右美托咪定0.4μg·kg~（-1）·h~（-1）至手术结束;后者则给予等容量的0.9%生理盐水。所有患者术前常规禁饮禁食;0.5mg阿托品和25mg异丙嗪为术前用药。手术开始时右美托咪定组持续静脉泵注右美托咪定0.4μg·kg~（-1）·h~（-1）至手术结束,生理盐水组则持续静脉泵注等容量的0.9%生理盐水至手术结束。观察两组患者全麻恢复期间呛咳反应情况;记录所有患者术后第一个24h及第二个24h切口引流量;记录麻醉诱导前(T0)、手术结束时(T1)、拔管前吸痰时(T2)、拔管时(T3)、拔管后5 min(T4)、10 min(T5)及15 min(T6)的MAP和HR变化;记录患者手术时间、麻醉时间、麻醉药用量、自主呼吸恢复时间、气管拔管时间、PACU停留时间及不良反应发生情况;使用QOR-40评分量表(40-item quality of recovery sowing system)评估两组患者术前、术后24h、术后48h、术后3个月、术后6个月时恢复质量;记录患者术后出血情况、切口愈合等级、术后住院时间、患者满意度;术后3、6个月时通过患者门诊随访及对其电话随访,收集肿瘤转移及复发情况。结果两组患者一般资料各指标(性别构成比、年龄、BMI、ASA分级构成比、高血压病史、糖尿病病史、手术时间、麻醉时间、术中冰冻结果、术前QOR-40评分总分)比较差异无统计学意义(P0.05)。与C组相比,D组全麻恢复期间呛咳发生率及呛咳强度降低,主要表现在带气管导管时,带管吸痰时和拔管时(P0.05);D组术后第一、二个24h引流量较C组减少(P0.05);与C组比较,D组T2~4时HR及MAP显著降低,围术期心动过速发生率降低(P0.05);D组丙泊酚、瑞芬太尼用量较C组减少(P0.05);与C组比较,D组术后24h的QOR-40评分较高,主要体现在情绪状态、身体舒适度、疼痛方面(P0.05);与C组比较,D组患者住院期间满意度较高;两组患者自主呼吸恢复时间、气管拔管时间、PACU停留时间、术后住院时间比较差异无统计学意义(P0.05)。两组患者切口愈合情况比较差异无统计学意义(P0.05)。两组患者术后3个月、6个月时QOR-40评分、满意度、肿瘤转移及复发情况比较差异无统计学意义(P0.05)。结论(1)术中持续输注0.4μg·kg~（-1）·h~（-1）剂量的右美托咪定能够有效减轻甲状腺手术患者全麻恢复期间的呛咳反应,具有良好的安全性;(2)术中持续输注0.4μg·kg~（-1）·h~（-1）剂量的右美托咪定能够维持甲状腺手术患者围术期血流动力学稳定,降低患者术后出血的风险,改善患者的早期恢复质量,对患者的远期术后恢复无影响。
[Abstract]:Objective to investigate the effect of Dexmedetomine Dex on cough response and postoperative recovery during general anesthesia recovery in patients undergoing thyroid surgery. Methods from December 2015 to June 2016, 118 patients who underwent thyroid tumor surgery in our hospital were randomly divided into two groups: dexmetomidine group and normal saline group. The former received intravenous infusion of dexmetomidine 0.4 渭 g kg-1) to the end of the operation at the beginning of operation, while the latter was given 0.9% saline of equal volume. All patients were routinely prohibited from drinking and fasting 0.5 mg atropine and 25mg promethazine before operation. At the beginning of operation, dexmetomidine group was continuously injected with dexmetomidine 0.4 渭 g kg 路kg ~ (-1) h ~ (-1) to the end of the operation, while in the saline group, 0.9% saline of the same volume was continuously injected to the end of the operation. The response of choking cough during the recovery of general anesthesia was observed in both groups, and the drainage flow of the first 24 hours and the second 24 hours after operation were recorded in all the patients. The changes of map and HR were recorded before anesthesia induction, at the end of operation, during sputum aspiration before extubation, during extubation, 5 min after extubation, 10 min T5 and 15 min T6), and the time of operation, dosage of anesthetic, recovery time of spontaneous respiration were recorded. Using QOR-40 score scale 40-item quality of recovery sowing system) to evaluate the quality of patients before, 24 hours, 48 hours, 3 months and 6 months after operation, and to record the bleeding after operation. The grade of wound healing, postoperative hospitalization time, patient satisfaction, and tumor metastasis and recurrence were collected by outpatient follow-up and telephone follow-up at 3 and 6 months after operation. Results there was no significant difference between the two groups in general data (sex composition ratio, age BMI-ASA grading ratio, history of hypertension, history of diabetes, operation time, anesthetic time, intraoperative freezing result, total score of QOR-40 score before operation). Compared with group C, the incidence of cough and the intensity of cough in group D were decreased during the recovery of general anesthesia. Compared with C group, HR and map in group D decreased significantly, the incidence of cardiac tachycardia in group C decreased during operation period, propofol and remifentanil dosage decreased compared with group C, and QOR-40 score in group D was higher than that in group C at 24 hours after operation, and the volume of remifentanil in group C was significantly lower than that in group C (P < 0.05), and the score of QOR-40 in group D was higher than that in group C (P < 0.05). Compared with group C, the satisfaction of group D was higher than that of group C; the time of spontaneous respiratory recovery and extubation of trachea and tracheal extubation and the duration of PACU stay were higher in group D than in group C, and were mainly reflected in their emotional state, physical comfort and pain. There was no significant difference in postoperative hospitalization time (P 0.05). There was no significant difference in wound healing between the two groups (P 0.05). There was no significant difference in QOR-40 score, satisfaction, tumor metastasis and recurrence between the two groups at 3 and 6 months postoperatively (P 0.05). Conclusion: continuous intraoperative infusion of 0.4 渭 g / kg of dexmetidine at a dose of 0.4 渭 g / kg / h can effectively reduce the cough response during the recovery of general anesthesia in patients undergoing thyroid surgery. Dexmetomidine (0.4 渭 g 路kg ~ (-1) 路h ~ (-1) can maintain hemodynamic stability, reduce the risk of postoperative bleeding and improve the quality of early recovery in patients undergoing thyroid surgery. It has no effect on the long-term postoperative recovery.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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