预注布托啡诺或地佐辛抑制依托咪酯诱发肌阵挛效果观察

发布时间：2018-08-04 18:20

【摘要】：目的探讨不同剂量布托啡诺或地佐辛预防依托咪酯注射后肌阵挛的可行性、安全性和有效性;比较两种药物对肌阵挛的抑制作用程度,同时为临床应用提供依据。方法本研究方案获天津医科大学第二医院医学伦理委员会批准,选择拟全麻下择期手术患者300例。性别不限,年龄40~65岁,ASA分级Ⅰ或Ⅱ级,体质指数(BMI)20~25 kg/m2,随机分为B、D两组,每组各150例。B组依照预注布托啡诺的剂量不同,再分为B1、B2、B3、B4、B5共5个亚组(n=30);D组依照预注地佐辛剂量不同,再分为D1、D2、D3、D4、D5共5个亚组(n=30)。所有患者入室前均不使用任何术前药物,入室后,连接监护仪,监测平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)以及脑电双频谱指数(BIS),用20G静脉留置针开放右上肢静脉,输注乳酸钠林格氏液。麻醉诱导前,B1~B4组分别静滴布托啡诺12.5μg/kg、15μg/kg、17.5μg/kg和20μg/kg;D1~D4组分别静滴地佐辛0.075 mg/kg、0.1 mg/kg、0.125 mg/kg和0.15 mg/kg。B5、D5两组为对照组,均滴注等容积生理盐水,规定每种药物的给药间均为30 s,在给予实验药物后的2 min各组均静脉注射依托咪酯0.3 mg/kg,并且注射时间均为1min,推注完毕后,立刻开始观察并记录B、D两组中肌阵挛发生的例数及强度,各组的观察时间均为2 min,在推注依托咪酯注射液的同时询问患者是否存在注射痛。同时记录全身麻醉诱导前(T_0)时刻、给予实验药物后2 min(T_1)时刻以及静脉注射依托咪酯后2 min(T_2)时刻,各时点每组患者的MAP、HR、SpO2和BIS值。并于全身麻醉诱导前(T_0)时刻以及气管插管后5 min(T_3)时刻,测定各组患者静脉血钾的浓度。同时观察与记录患者头晕、恶心、呕吐等不良反应的发生情况。结果在B组中,各亚组患者肌阵挛的发生率分别为33%、10%、10%、10%、70%。与B5组相比,B1、B2、B3、B4四组肌阵挛的发生率和强度均明显降低,差别有统计学意义(P0.05),B2、B3、B4三组与B1组相比较,差异有统计学意义(P0.05),B2、B3、B4三组相比,无明显统计学差异(P0.05)。B2与B3、B4两组相比,不良反应发生的最少。B1、B2、B3、B4、B5五个亚组,患者注射痛的发生率分别为17%、10%、10%、7%、20%,各亚组患者注射痛的发生率和强度差别无统计学意义(P0.05)。T_0、T_1与T_2时刻五个亚组患者的MAP、HR、SpO2差异无统计学意义(P0.05),T_1时刻B4组与其他四组相比,BIS值有所降低,差异有统计学意义(P0.05),T_0、T_2时刻五个亚组患者的BIS值差异无统计学意义(P0.05)。D组中,各亚组患者肌阵挛的发生率分别为43%、20%、20%、20%、70%。与D5组相比,D1、D2、D3、D4四组肌阵挛的发生率和强度均明显降低,差别有统计学意义(P0.05),D2、D3、D4三组与D1组相比较差异有统计学意义(P0.05),D2、D3、D4三组相比较无明显差异(P0.05)。D2与D3、D4两组相比,不良反应发生的最少。D1、D2、D3、D4、D5五个亚组患者注射痛的发生率分别为13%、13%、10%、7%、20%,各组患者注射痛的发生率和强度差别无统计学意义(P0.05)。T_0、T_1与T_2时刻5组患者的MAP、HR、SpO2、BIS值差异无统计学意义(P0.05)。B2与D2组相比,肌阵挛发生率及强度差异无统计学意义(P0.05);两组患者注射痛的发生率和强度差别无统计学意义(P0.05)。T_0、T_1与T_2时刻2组患者的MAP、HR、SpO2、BIS值差异无统计学意义(P0.05)。T_3与T_0时比较,无肌阵挛(肌阵挛强度0级)及发生1级与2级肌阵挛的患者静脉血钾的浓度均没有明显变化(P0.05);有严重肌阵挛发生的患者(肌阵挛强度3级)静脉血钾的浓度明显升高(P0.05)。结论严重肌阵挛的患者血钾浓度会有所升高,而且有部分患者发生肌肉酸痛。预先静脉注射布托啡诺15.0μg/kg与12.5μg/kg、17.5μg/kg、20μg/kg布托啡诺相比更能安全、有效地抑制静脉注射依托咪酯引起的肌阵挛;预先静脉注射地佐辛0.100 mg/kg与0.075 mg/kg、0.125 mg/kg、0.150 mg/kg地佐辛相比更能安全、有效地抑制肌阵挛的发生。预先静脉注射布托啡诺15.0μg/kg与地佐辛0.100mg/kg相比对肌阵挛的抑制效果无明显差异,同时这两种剂量的两种药物引起的不良反应较少,并且二者对循环和呼吸系统的影响亦无差异。
[Abstract]:Objective to explore the feasibility, safety and effectiveness of the myoclonus after etomidate injection of different doses of Bhutto enphonic or dezocine, to compare the degree of inhibition of the two drugs on myoclonus, and to provide a basis for clinical application. Methods the study was approved by the medical ethics committee of Second Hospital Affiliated to Tianjin Medical University. 300 patients undergoing elective surgery under anesthesia, gender, age 40~65, ASA grade I or class II, body mass index (BMI) 20~25 kg/m2, were randomly divided into B, D two, and 150.B groups in each group were divided into B1, B2, B3, B4, and 5 subgroups according to the dosage of pre injected Bhutto phine. 5 subgroups (n=30). All patients did not use any preoperatively before entering the room. After entering the room, connecting monitor, monitoring the mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and electroencephalogram double spectrum index (BIS), using 20G venous indwelling needle to open the right upper limb vein and infusion of sodium lactate Ringer's solution. Before induction, the B1~B4 group was static, respectively. Drop Bhutto enphine 12.5 mu g/kg, 15 mu g/kg, 17.5 mu g/kg and 20 mu g/kg, D1~D4 group static drops of zocin 0.075 mg/kg, 0.1 mg/kg, 0.125 mg/kg and 0.15 mg/kg.B5, and D5 two group as control group, both drip and other volume physiological saline, which stipulate that the drug delivery between each drug is 30 s. After giving the experimental drugs, each group of 2 min is intravenously injected etomidate 0.3 G/kg, and the time of injection was 1min. After the injection, we immediately began to observe and record the number and intensity of myoclonus in the B, D two groups. The observation time of each group was 2 min. At the same time, the patients were asked if there was an injection pain at the same time, and the time before the induction of general anesthesia (T_0) was recorded and 2 MI after the experimental drug was given. At the time of n (T_1) and 2 min (T_2) time after intravenous etomidate, the values of MAP, HR, SpO2 and BIS at each time point were measured at each time point. The concentrations of potassium in venous blood were measured in each group of patients before and before the induction of general anesthesia (T_0) and at the 5 min (T_3) at the endotracheal intubation. The occurrence of adverse reactions such as dizziness, nausea and vomiting were observed and recorded. Results in group B, the incidence of myoclonus was 33%, 10%, 10%, 10%. Compared with group B5, the incidence and intensity of myoclonus in group B1, B2, B3, B4 four were significantly lower, and the difference was statistically significant (P0.05), B2, B3, B4 three, compared with the B1 group, there was no statistically significant difference. Difference (P0.05).B2 was the least.B1, B2, B3, B4, B5 five subgroups of B3 and B4 two groups, and the incidence of injection pain in patients was 17%, 10%, 10%, 7%, 20%. There was no statistically significant difference in the incidence and intensity of injection pain in the subgroups of the subgroups (P0.05).T_0, and there was no statistical difference between the T_1 and the five subgroups (P0.05), at the time of T_1, the BIS value of group B4 was lower than that of the other four groups, and the difference was statistically significant (P0.05), T_0, and T_2 time of the five subgroups had no statistical significance (P0.05).D group, and the incidence of myoclonus in each subgroup was 43%, 20%, 20%, 20%, and 70%. compared with the D5 group, and the incidence and strength of the four groups of myoclonus The difference was statistically significant (P0.05), D2, D3, D4 three and D1 group were statistically significant (P0.05), D2, D3, D4 three groups had no significant difference (P0.05).D2 and D3, five subgroups of adverse reactions were 13%, 13%, 10%, 7%, 20%, respectively. There was no significant difference in the incidence and intensity of injection pain in patients (P0.05).T_0, T_1 and T_2 at the time of MAP, HR, SpO2, BIS value difference was not statistically significant (P0.05).B2 and D2 group, there was no significant difference in the incidence and intensity of myoclonus (P0.05); the incidence and intensity of injection pain in the two groups had no statistical significance. .T_0, T_1, and T_2 time 2 groups of patients with MAP, HR, SpO2, BIS values were not statistically significant (P0.05).T_3 and T_0 compared, no myoclonus (myoclonus intensity 0) and 1 and 2 stage myoclonus of patients with venous blood potassium concentration did not change significantly (P0.05); there are severe myoclonus (3 levels of myoclonus strength 3) concentration of venous blood potassium concentration Significant increase (P0.05). Conclusion the concentration of blood potassium in patients with severe myoclonus will increase, and some patients have muscle soreness. The pre intravenous injection of Bhutto enphine 15 mu g/kg and 12.5 mu g/kg, 17.5 u g/kg, 20 mu g/kg Bhutto enphine can be more safe and effective to inhibit myoclonus caused by intravenous etomidate; pre intravenous injection. Dezocin 0.100 mg/kg is safer and more effective than 0.075 mg/kg, 0.125 mg/kg, 0.150 mg/kg, and effectively inhibits the occurrence of myoclonus. There is no significant difference in the inhibition of myoclonus by pre intravenous injection of Bhutto eno 15 UX 0.100mg/kg to dezocin 0.100mg/kg, and fewer adverse reactions caused by two kinds of drugs of these two doses, and There was no difference in the effects of the two on circulation and respiratory system.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R614.2

【参考文献】