长托宁预先给药在腰硬联合麻醉中应用的临床观察

发布时间：2018-07-05 07:34

本文选题：长托宁 + 腰硬联合麻醉　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：探讨长托宁预先给药防治腰硬联合麻醉后寒战的有效率，，以及患者血流动力学变化及镇静效果。方法：将80例择期行全子宫切除手术患者的ASAI~II级、年龄45~60岁,体重50~70kg，身高155~165cm,BMI18~25kg/m2的病人随机分为两组：A组（长托宁组)、B组（空白对照组）。于麻醉开始前5min，A组静脉注射长托宁0.01mg/kg(用生理盐水稀释到2ml)，B组静脉注射相同体积的生理盐水。患者采取右侧卧位，于L2-3间隙穿刺进入蛛网膜下间隙后，匀速推注0.75%的布比卡因2.0ml（10-20sec内），置入导管于硬膜外间隙。固定导管后患者改为平卧位，用体位法调整阻滞平面在T6以下。术中根据腰麻作用减退情况酌情经硬膜外导管追加利多卡因3～5ml。术中连续监测ECG、NIBP，并记录入室（T1）、切皮（T2）、牵拉腹膜(T3)、探查盆腹腔(T4)、牵拉子宫(T5)、关腹(T6)、手术结束(T7)时的心率（HR）及平均动脉压（MAP）。患者入室时的HR及MAP采用患者在手术床上静卧10分钟后的HR及MAP。观察寒战发生率。观察并记录试验对象的镇静评分（Ramsay评分）。结果：（1）两组病人的一般情况，两组患者的ASA分级、年龄、体重，输液量，出血量，尿量，冲洗量和手术时间的差异无统计学意义（P0.05）。（2）两组患者麻醉后，MAP均有所下降，与入室时相比有统计学意义（P0.05），手术快结束时恢复至基础水平。两组患者均于牵拉子宫时MAP最低，B组MAP降低较A组有统计学意义（P0.05），其余各时间点各组间无统计学差异（P0.05）。组内比较，A组静注长托宁后，各时间点HR与基础值相比无显著差异（P0.05），而B组在牵拉腹膜、腹腔探查及牵拉子宫时，心率有所下降，（T3、T4、T5）与T1相比，有统计学意义（P0.05）。组间比较，两组患者在牵拉子宫时HR差别有统计学意义（P0.05），其余各时间点均无显著差异（P0.05）。（3）A组的镇静评分明显高于B组（P0.05）。两组寒战发生率经检验，差异具有统计学意义（P0.05）。两组患者恶心呕吐发生率无明显差异（P0.05）。结论：长托宁预先给药在腰硬联合麻醉中应用有利于患者血流动力学稳定，减少寒战发生率，同时提高患者的镇静满意度，无药物不良反应的发生。
[Abstract]:Objective: to investigate the efficacy of Changtonin in preventing and treating shivering after combined spinal-epidural anesthesia, hemodynamic changes and sedative effect. Methods: 80 patients with ASAI II, aged from 45 to 60 years old, weighing 50 ~ 70 kg and standing 155 ~ 165 cm / m ~ (-1) BMI18 ~ (18) kg / m ~ 2, were randomly divided into two groups: group A (Changtonin group) and group B (blank control group). Five minutes before anesthesia, group A was injected with Changtonin 0.01mg/kg (diluted to 2ml with normal saline) and group B was injected with the same volume of saline. In the right lateral position, the patients were punctured into the subarachnoid space in the L2-3 space, and 0.75% bupivacaine 2.0ml (10-20sec) was injected uniformly. The catheter was placed in the epidural space. After fixing catheter, the patient changed to supine position and adjusted the block level below T 6 by posture. According to the hypofunction of spinal anaesthesia, Lidocaine was added through epidural catheter at 5 ml. During the operation, continuous monitoring of ECGV NIBP was performed, and the heart rate (HR) and mean arterial pressure (map) at the end of operation (T7) were recorded, and the heart rate (HR) and mean arterial pressure (map) were recorded at the end of operation (T7), peritoneal traction (T3), pelvic exploration (T4), traction uterus (T5), closure of abdomen (T6), heart rate (HR) and mean arterial pressure (map) at the end of operation (T7). HR and map of the patients at the time of entering the room were treated with HR and MAPP after 10 minutes of lying still on the operating bed. Observe the incidence of shivering. The sedation score (Ramsay score) was observed and recorded. Results: (1) there was no significant difference in ASA grade, age, body weight, transfusion volume, blood loss, urine volume, irrigation volume and operation time between the two groups (P0.05). (2). Compared with the time of entry, there was statistical significance (P0.05), the operation was almost over to the basic level. The decrease of map in group B was significantly lower than that in group A (P0.05), but there was no significant difference between the other groups at each time point (P0.05). There was no significant difference in HR between group A and T 1 after intravenously injection of Changtonin (P0.05), but in group B, the heart rate decreased when pulling peritoneum, exploring abdominal cavity and pulling uterus, (T3, T4, T5) compared with T1 (P0.05). There was significant difference in HR between the two groups when pulling uterus (P0.05). There was no significant difference in other time points (P0.05). (3). The sedation score of group A was significantly higher than that of group B (P0.05). The incidence of shivering in the two groups was statistically significant (P0.05). There was no significant difference in the incidence of nausea and vomiting between the two groups (P0.05). Conclusion: the application of Changtonin in combined spinal-epidural anesthesia is beneficial to hemodynamics stability, reduce the incidence of shivering, improve the patients' sedation satisfaction, and no adverse drug reactions.
【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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