右旋美托咪啶对癫痫病灶切除患者术后早期认知功能的影响

发布时间：2018-06-19 19:49

本文选题：右旋美托咪定 + 高选择性癫痫病灶切除术　；参考：《中南大学》2014年硕士论文

【摘要】：目的：右旋美托咪定作为一种特异性很高的α2肾上腺素能受体激动剂,其产生的镇静及催眠作用与用药的剂量相关,而且它对位于中枢神经系统及外周的α2受体的兴奋作用,可产生镇痛、阻滞交感神经的作用,并对应激反应的产生一定的抑制。本研究主要是探讨在高选择性癫痫病灶切除术中应用右旋美托咪定后对术后认知功能的影响。方法：选择湖南省第二人民医院癫痫手术44例,年龄18至45岁,手术种类为高选择性癫痫病灶切除术,手术均为选择性切除右侧颞叶部分海马、杏仁核及软化灶。随机将44例病人分为两组,一组为对照组(C组),另外一组为右旋美托咪定组(D组),每组22例患者。D组在麻醉诱导开始之前静脉给予右旋美托咪定,按0.6ug/kg计算,于15分钟内泵注完毕,之后改0.4ug/kg/h持续泵入至手术结束。对照组(C组)注射等量计算的生理盐水。两组均采用咪达唑仑(0.05mg/kg)、丙泊酚(1mg/kg)、芬太尼(3μ g/kg)、阿曲库铵(0.6mg/kg)行全麻诱导气管插管后麻醉机控制呼吸,所有病人麻醉均采用全静脉给药,维持阶段靠丙泊酚泵入镇静,两组均间断追加阿曲库铵维持肌松,并追加芬太尼镇痛。术中机械通气,根据实际情况调整呼吸参数。按术中生命体征监测决定麻醉药的追加剂量的调整,尽可能BIS值维持在40-55,使血压平稳,波动不超过术前基础血压上下20%的范围,术中出现血压降至基础值的20%以下,则予静注麻黄素升压调整,予以记录输液量、出血量及尿量。所有患者予以持续自控镇痛,配方为：舒芬太尼2ug/kg+托烷司琼5mg,加入生理盐水稀释,总量为80ml。分别在麻醉诱导前10分钟(T1)、手术切皮开始后10分钟(T2)、送入术后恢复室后10分钟(T3)抽取未输液侧静脉血,测定皮质醇及血糖值。选取手术前一日与手术后的第七日从韦氏成人智力量表(WAIS)及记忆量表(WMS)里抽取七个敏感项目对患者进行测验。选用国际术后认知功能障碍研究组建议的复合Z分法判断标准行术后认知功能障碍的判断,以是否有一个以上的单项测验中,Z分大于1.96亦或复合Z分大于1.96,作为发生术后认知功能障碍的标准。结果：1.两组病患手术前一般情况(性别比、岁数、体重、ASA的分级),无明显统计学差异(P0.05)；2.两组手术时间,出血量,液体量及术中阿曲库铵的用量无显著差异,D组中芬太尼及丙泊酚用量较C组减少,有统计学差异(P0.05)；3.全麻诱导插管后D组中皮质醇的浓度下降较C组浓度显著,有统计学差异(P0.05)。4.C组患者中术后出现认知功能障碍为6例,其发生率是30%,D组患者术后出现认知功能障碍仅为1例,发生率是4.76%。同C组比较,D组术后出现认知功能障碍的发生率较低,有统计学差异(P0.05)。结论：1.在高选择性癫痫病灶切除术中应用右旋美托咪定可降低患者术后早期认知功能障碍的发生率。2.在高选择性癫痫病灶切除术中应用负荷剂量0.6ug/kg,维持剂量0.4ug/kg/h的右旋美托咪定能减少术中丙泊酚及芬太尼等麻醉药物的用药量。图1幅,表10个,参考文献48篇
[Abstract]:Objective : To study the effects of dexamatomitin as a specific high 伪 2 adrenergic receptor agonist on the sedative and hypnotic effects of 伪 2 adrenergic receptor in the central nervous system and the peripheral . It can produce analgesia , block sympathetic nerve , and inhibit the stress response .

Methods : Forty - four patients were randomly divided into two groups ( group C ) , propofol ( 1 mg / kg ) , fentanyl ( 3 渭g / kg ) , atracurium ( 0.6 mg / kg ) .

Results : 1 . There was no significant difference between the two groups before operation ( sex ratio , age , weight , ASA grade ) ( P0.05 ) .
2 . There was no significant difference between the two groups of operation time , bleeding volume , amount of liquid and amount of atracurium in operation , and the dosage of fentanyl and propofol in group D was lower than that in group C ( P0.05 ) .
3 . The concentration of cortisol in group D after induction of general anesthesia was significantly lower than that in group C ( P0.05 ) . There were 6 cases with cognitive impairment after operation in group D . The incidence rate was 30 % . In group D , the cognitive dysfunction was only 1 case and the incidence rate was 4.76 % . Compared with group C , the incidence of cognitive impairment was lower in group D . There was statistical difference ( P0.05 ) .

Conclusion : 1 . The incidence of early cognitive dysfunction in patients with high - selectivity epilepsy can be reduced .
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

【参考文献】