三种不同麻醉方法用于腹部手术患者麻醉质量分析

发布时间：2018-06-21 23:09

本文选题：麻醉质量 + 全麻复合硬膜外麻醉　；参考：《吉林大学》2014年硕士论文

【摘要】：麻醉质量是保证术中患者安全的关键因素，麻醉质量包括手术麻醉时患者生命体征平稳、内环境稳定、无疼痛，全麻患者还应包括无意识并记忆消失、停麻醉后苏醒快和平稳、患者满意度高，尽量节省麻醉费用，同时还要满足手术医生的要求。麻醉是否成功关键在于麻醉质量，随着外科学发展，手术范围不断扩大，手术种类不断增多，患者麻醉及手术安全性越来越受到关注。有报道称，至上世纪末麻醉相关死亡率为0.14‰，其原因有麻醉管理不当、麻醉方法选择不正确以及麻醉设备使用不当等。不同资料从不同角度研究麻醉质量对麻醉安全性的影响，然而多是从麻醉准备、麻醉方法选择或是麻醉药物选择等不同的侧面，通过观察进行临床总结，取得一定的经验，尚缺乏有关麻醉方法影响麻醉质量的系统性研究，麻醉质量受多种因素影响，因此本研究从麻醉方法、麻醉用药以及术中麻醉维持等方面探讨影响麻醉质量的原因及如何提高麻醉质量。目的本研究对不同麻醉方式患者循环功能、内环境稳定指标、气管导管拔出时间及苏醒时间、术后不良反应、躁动情况、患者术中知晓情况、术后麻醉满意度、麻醉费用等麻醉质量相关指标进行比较分析；并探讨相同组别不同观察时间点循环功能变化、血中肾上腺素（EPI）及去甲肾上腺素（NA）浓度、血气检测结果、术后痛觉评分变化情况，综合评价麻醉质量，以期为临床麻醉工作提供相应参考。方法选取2013年11月至2014年3月，辽宁省人民医院普外科全身麻醉或全身麻醉复合硬膜外麻醉下腹部胃、肠手术患者150例，随机数字法分为G1组（吸入七氟烷＋丙泊酚＋维库溴铵）、G2组（吸入七氟烷＋瑞芬太尼＋丙泊酚＋维库溴铵）和GE组（吸入七氟烷＋丙泊酚＋维库溴铵＋连续硬膜外麻醉），每组各50例。收集患者循环功能变化、内环境稳定指标、患者术中输液量、尿量、麻醉药用量、术后不良反应、麻醉费用等麻醉质量相关因素。采用Excel表格录入数据，SPSS18.0进行统计分析。计量资料采用均数±标准差（x±ｓ）表示，采用t检验或方差分析进行比较；计数资料用率或构成比表示。显著性水平为P＜0.05。结果 1.循环功能变化：G1组各时间点SBP值均高于GE组，G2组T5、T6、T7SBP值均高于GE组； G1组除T2点之外各时间点DBP值均高于GE组，G2组T1、T3、T4、T5时间点DBP值均高于GE组；G1组除T1外，其余时间点HR值均高于GE组，，G2组仅T1点HR值显著高于GE组；G1组T1、T2BIS值显著高于GE组，T4、T5、T6、T7点低于GE组，G2组T4、T5、T6、T7点均显著低于GE组。 2.内环境稳定指标：G1组T2时间点SpO2值低于GE组，T6时间点SpO2值高于GE组，G2组T6、T7高于GE组；G1组在三个观察时间点EPI、NA浓度均显著高于GE组；GE组T4时间点PaCO2浓度均高于G1组和G2组，GE组T6时间点血PaO2值低于G1组，GE组T4、T5、T6时间点血PaO2值均低于G2组；G1组在T0、T4时间点Hb值均高于G2组及GE组。 3. GE组气管导管拔出时间及苏醒时间与G1组和G2组比较均显著缩短。G2组气管导管拔出时Riker评分相对较高，显著高于G1组。 4.七氟烷用量GE组显著少于G1组和G2组；丙泊酚用量GE组显著少于G1组；维库溴铵用量GE组显著少于G1组。 5.三组患者术中输液量、麻醉费用无差异；术中均无知晓、无躁动；术后不良反应较少，且均较轻。GE组患者术中尿量显著高于G1、G2组 6. GE组患者术后12~24h痛觉评分显著低于G1组。GE组患者麻醉满意度相对较高。结论 1.三种麻醉方法均能满足患者手术要求，术中无痛觉、无知晓。 2.手术结束停麻醉后苏醒较快、气管拔管时无躁动。 3.术后恶心、呕吐及头晕发病率低，无其他并发症。 4.综合评价，全麻复合硬膜外阻滞麻醉质量最优，是腹部手术的首选方法。
[Abstract]:Anesthesia quality is the key factor to ensure the patient ' s safety during operation . The anesthesia quality includes the patient ' s vital signs , stable internal environment and no pain after anesthesia .

Purpose

In this study , the indexes of circulatory function , internal environment stabilization index , tracheal catheter withdrawal time and wake - up time , postoperative adverse reaction , agitation , patient ' s knowledge , postoperative anesthesia satisfaction and anesthesia cost were compared .
The changes of circulating function , the concentration of epinephrine ( EPI ) and noradrenaline ( NA ) in the same group , the results of blood gas detection and the change of postoperative pain score were discussed , and the quality of anesthesia was evaluated comprehensively with a view to providing a corresponding reference for clinical anesthesia .

method

In November 2013 to March 2014 , 150 patients undergoing general anesthesia or general anesthesia combined epidural anesthesia with general anesthesia or general anesthesia were randomly divided into two groups : G1 group ( inhaled heptafluoroalkane + propofol + vecuronium bromide ) , group G2 ( inhaled heptafluoroalkane + propofol + vecuronium bromide ) and GE group ( inhaled heptafluoroalkane + propofol + vecuronium bromide + continuous epidural anesthesia ) .
The significance level was P & lt ; 0.05 .

Results

1 . The change of circulating function : SBP value in G1 group was higher than that of GE group and group G2 T5 , T6 and T7SBP were higher than GE group .
The DBP values of G1 , T3 , T4 and T5 were higher than those of GE group except for T2 .
The HR value of G1 group was higher than that of GE group except T1 , and the HR value of group G2 was significantly higher than that of GE group .
The T1 and T2BIS values in G1 group were significantly higher than those of GE group , T4 , T5 , T6 , T7 point lower than GE group , group G2 T4 , T5 , T6 and T7 were significantly lower than GE group .

2 . Internal environmental stability index : SpO2 value in G1 group was lower than that of GE group , and SpO2 value was higher than that of GE group and T6 and T7 in group G2 were higher than GE group .
The concentration of EPI and NA was significantly higher in G1 group than in GE group .
The concentration of PaCO 2 in the GE group was higher than that in G1 group and G2 group , and the time point of the GE group was lower than that in G1 group , and that of GE group T4 , T5 and T6 was lower than G2 group .
The Hb value of G1 group at T0 and T4 was higher than that of G2 group and GE group .

3 . Compared with G1 and G2 groups , the time and time of tracheal catheter withdrawal from GE group were significantly shorter than those in G1 and G2 groups . Riker score was higher in G2 group than in G1 group .

4 . The GE group was significantly less than G1 and G2 group .
The dosage of propofol was significantly lower in GE group than in G1 group .
The dose of vecuronium was significantly lower in GE group than in G1 group .

5 . There was no difference in infusion volume and anesthesia cost in three groups .
There was no awareness in the operation , no agitation ;
In GE group , the urinary volume was significantly higher in GE group than in G1 and G2 group .

6 . The pain score of patients with GE group was significantly lower than that in G1 group .

Conclusion

1 . Three kinds of anesthesia methods can meet the requirements of the patient ' s operation , no pain in operation and no knowledge .

2 . At the end of the operation , it was quicker to wake up after anesthesia , and there was no agitation in the tracheal extubulation .

3 . Postoperative nausea , vomiting and dizziness were low and there were no other complications .

4 . Comprehensive evaluation , general anesthesia combined epidural anesthesia quality optimal , is the preferred method of abdominal surgery .
【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】：R614.2

【参考文献】