右美托咪定和芬氟合剂对颈丛阻滞下甲状腺手术患者镇静比较研究

发布时间：2018-06-13 06:37

本文选题：颈丛阻滞 + 右美托咪定　；参考：《山东大学》2014年硕士论文

【摘要】：目的以芬氟合剂为对照,探讨右美托咪定对颈丛阻滞下甲状腺手术患者镇静的有效性和安全性。方法择期颈丛阻滞下甲状腺手术患者60例,ASA1或Ⅱ级,随机均分为：右美托咪定组(D组,30例)和对照组(C组,30例),D组缓慢输入0.5ug/kg右美托咪定(10min内),C组缓慢静脉芬氟合剂1/2量,颈丛阻滞采用一点双侧法,药物0.375%的罗哌卡因40ml。记录入室时(T0)、阻滞后5min(T1)、10min已经切皮(T2)、30min (T3).60min (T4)MBP、HR、RR、SPO2,每时段抽取3ml外周肘静脉血,注入干燥的试管内3O00r/min离心15min抽取血清置于-70度低温箱保存,收齐标本后用放射免疫法测定血浆皮质醇(Cor)浓度以及去甲肾上腺素(E)和肾上腺素(NE)浓度(试剂盒由深圳巨丰科技公司提供),记录术中Ramsay评分；记录手术过程中呛咳和肢体躁动评分；记录不良反应发生情况。术后24h随访患者用药后至手术结束前对有关操作的遗忘程度。结果与C组比较,T1-T4时D组Ramsay评分明显较低,差异有统计学意义(P0.05)与D组比较,T1-T4时C组的BP、HR明显升高(P0.05)；与T0比较,T1-T4时D组的BP、HR差异无统计学意义(P0.05),而C组的BP、HR差异有统计学意义(P0.05)；与T0时比较,血浆皮质醇(Cor)浓度以及去甲肾上腺素(E)和肾上腺素(NE)浓度变化有统计学意义(P0.05),T2-T4时D组与C组比较也有统计学意义；SPO2两组比较两组差异无统计学意义(P0.05)；术后24h随访,D组顺行性遗忘程度高于C组(P0.05);D组呛咳评分1分为9例(30%)、躁动评分0-1分为27例(90%),分别多于C组的18例(60%)和19(63.4%).两组患者未出现恶心、呕吐、低血压、局麻药中毒等不良反应。结论右美托咪定0.5ug/kg麻醉前10min缓慢静脉输注,增强颈丛阻滞甲状腺手术患者的镇静效果,循环稳定,无呼吸抑制,但偶发心动过缓。
[Abstract]:Objective to investigate the efficacy and safety of dexmetomidine in the treatment of thyroid surgery under cervical plexus block. Methods Sixty patients undergoing selective cervical plexus block thyroidectomy were randomly divided into two groups: dexmetomidine group (n = 30) and control group (n = 30). 30 patients in control group C were treated with 0.5ug/kg dexmetomidine within 10 minutes. Cervical plexus block was performed with a bilateral method with 0.375% ropivacaine 40 ml. After 5 minutes of block, the skin was cut to T2P for 30 minutes, and T4MBPHRH / RRN SPO2 was used to extract the blood of peripheral elbow vein of 3ml at each time, and then injected into dry test tube with 3 O00r-min centrifuge 15min to store the serum in -70 degree hypothermia box, and the results showed that the blood samples were stored in a -70 degree hypothermia box, and the blood samples were stored in a -70 degree hypothermia box at each time, and the blood samples were collected from the peripheral elbow vein of 3ml. After receiving the samples, the plasma cortisol cortisone concentration, norepinephrine (E) and epinephrine (NE) concentration were measured by radioimmunoassay (the kit was provided by Shenzhen Jufeng Technology Company), and Ramsay score was recorded during the operation. To record the score of cough and limb restlessness during operation, and to record the occurrence of adverse reactions. The degree of forgetfulness of the operation after 24 h follow-up to the end of the operation. Results the Ramsay score of group D was significantly lower than that of group C at T1-T4 (P 0.05). The BPHR of group C at T1-T4 was significantly higher than that of group D at T1-T4. There was no significant difference in BPU HR between group D and T0, but there was significant difference between group C and group C (P 0.05), and there was no significant difference between group D and T0. There were significant differences in plasma cortisol (Corn), norepinephrine (E) and epinephrine (NE) concentrations between group D and group C when compared with group C (P 0.05). There was no significant difference between group D and group C (P 0.05). The degree of antegrade amnesia in group D was higher than that in group C (P 0.05). The score of dysphagia in group D was divided into 9 cases (30 cases), restlessness score (0-1) was divided into 27 cases (90 cases), which was more than that in group C (18 cases) and 1963.4% (P < 0.05). There were no adverse reactions such as nausea, vomiting, hypotension and local anaesthetic poisoning in the two groups. Conclusion the slow intravenous infusion of 10min before dexmetomidine 0.5ug/kg anesthesia can enhance the sedation effect of cervical plexus block thyroid surgery patients with stable circulation and no respiratory inhibition but occasional bradycardia.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

【相似文献】