右美托咪定在神经外科患者行DSA检查时的应用

发布时间：2018-08-15 11:54

【摘要】：研究目的：数字剪影血管造影能清楚地显示颈内动脉、椎基底动脉、颅内大血管及大脑半球的血管图像，还可测定动脉的血流量，目前已被应用于脑血管病检查，特别是对于动脉瘤、动静脉畸形等定性定位诊断，更是最佳的诊断手段。部分病人的恐惧心理，或者严重颅脑损伤的患者烦躁、不配合使检查过程难以进行，并且造成患者心理及生理上的不适感。本文目的在于研究应用盐酸右美托咪定在DSA检查中对患者进行适当的镇静，观察右美托咪定应用于神经外科患者DSA检查时的镇静效果,使之消除患者紧张恐惧心理，使患者的检查过程更加舒适，使躁动患者能够配合检查，缩短检查过程所需时间，并提高准确性，为患者的病情诊断提供更有效、准确的依据。研究方法：选择2013年8月-2013年12月在吉林大学第二医院神经外科需要行DSA检查的患者60例。采用随机双盲的方法分为A：右美托咪定组，B：咪达唑仑组，C：对照组,每组患者20例。三组患者在性别、年龄、体重方面无显著性差异。 A组入选患者给予右美托咪定负荷剂量1μg/kg，负荷剂量输注时间设置为15分钟。负荷量完毕后，再0.1-0.7μg/kg/h维持。在手术结束10分钟前停药。 B组入选患者后经静脉咪达唑仑组首先给予0.05mg/kg咪达唑仑负荷剂量,注药时间1min,再0.02～0.1mg/kg/h的速度维持,老年患者适当降低用量。手术结束前10分钟停药。 C组入选患者入导管室后经静脉给予生理盐水5ml。三组患者待手术开始时，术者使用2%的利多卡因对需要穿刺部位行局部浸润麻醉。分别记录入选患者给药前(T0)、给药后5min(T1)、造影前(T2)、造影局麻置管时(T3)、置管后10min(T4),造影结束后5min (T5）的血压（BP）、心率（HR）、脉搏血氧饱和度（SPO2）,并记录各组患者各时间点的镇痛、镇静程度。所有实验数据统计分析采用SPSS21.0软件包，以P0.05为检验水准，说明统计学意义。结果：三组病例T0-T2时段MAP无明显差异。对照组MAP从T3开始明显升高，持续至T5检查结束。右美托咪定组与咪达唑仑组无MAP的明显上升，右美托咪定组较咪达唑仑组MAP波动更小。 T0时三组病例HR无差异，T1-T4对照组HR持续升高，至T5略有下降趋势，但与T0相比升高明显。右美托咪定组与咪达唑仑组心率变化不明显，两实验组无明显差异。 Ramsay评分在T0时三组间的差异无统计学意义，而在T1-T5时差异显著，且右美托咪定与咪达唑仑组的镇静评分显著低于对照组。T2、T5时右美托咪定组略高于咪达唑仑组，，P0.05。 VAS评分在T0时三组组间的差异无统计学意义，，而在T1-T5时差异显著，且两实验组镇痛评分显著低于对照组。T3时右美托咪定组较咪达唑仑组低，P=0.047。对照组无呼吸抑制，T0时三组无差异，T1-T4两实验组与对照组差异明显，P0.01。T5时无差异，P0.05。T1-T3时咪达唑仑组略高于右美托咪定组。对照组合作度相对较差。不良反应方面，对照组高血压与心动过速发生率较高，P0.01。其他方面无明显差异。结论：右美托咪定与咪达唑仑应用于神经外科DSA检查的患者时能够起到良好的镇静作用，不良反应少，并且与咪达唑仑相比，右美托咪定具有一定的镇痛效果，呼吸道抑制轻微，患者血流动力学更加平稳。
[Abstract]:Research purposes:
Digital silhouette angiography can clearly display the images of internal carotid artery, vertebrobasilar artery, intracranial large vessels and cerebral hemisphere, and can also measure the blood flow of arteries. It has been used in the examination of cerebrovascular diseases, especially for qualitative localization diagnosis of aneurysms, arteriovenous malformations and so on. The purpose of this study was to investigate the sedation effect of dexmedetomidine hydrochloride in DSA and to observe the sedation effect of dexmedetomidine hydrochloride in DSA for neurosurgical patients. The effect is to eliminate the patient's nervousness and fear, make the patient's examination process more comfortable, so that restless patients can cooperate with the examination, shorten the time required for the examination process, and improve the accuracy, so as to provide more effective and accurate basis for the diagnosis of the patient's condition.
Research methods:
Sixty patients who needed DSA examination in neurosurgery department of the Second Hospital of Jilin University from August 2013 to December 2013 were randomly divided into A: dexmedetomidine group, B: midazolam group and C: control group. There were no significant differences in sex, age and weight among the three groups.
Patients in group A were given dexmedetomidine at a loading dose of 1 ug/kg for 15 minutes and then maintained at a loading dose of 0.1-0.7 ug/kg/h.
In group B, the loading dose of midazolam was 0.05 mg/kg, the injection time was 1 minute, and the speed was maintained at 0.02-0.1 mg/kg/h. The dosage of midazolam was reduced appropriately in the elderly patients.
Patients in group C were given intravenous saline after intravenous infusion into the catheter room of group 5ml..
At the beginning of surgery, the surgeons in the three groups used 2% lidocaine for local infiltration anesthesia at the needle site.
The blood pressure (BP), heart rate (HR) and pulse oxygen saturation (SPO2) were recorded before administration (T0), 5 minutes after administration (T1), before angiography (T2), during local anesthesia (T3), 10 minutes after angiography (T4), 5 minutes after angiography (T5), and the analgesia and sedation were recorded. All experimental data were analyzed by SPSS21.0 software. P0.05 is used as a test level to illustrate the statistical significance.
Result:
There was no significant difference in MAP between the three groups at T0-T2. MAP in the control group increased significantly from T3 until the end of T5. There was no significant increase in MAP between dexmedetomidine and midazolam groups. MAP fluctuated less in dexmedetomidine group than midazolam group.
There was no difference in HR between the three groups at T0. HR in the T1-T4 control group continued to increase until T5 decreased slightly, but increased significantly compared with T0. There was no significant difference in HR between dexmedetomidine group and midazolam group.
There was no significant difference in Ramsay score between the three groups at T0, but significant difference at T1-T5. The sedation score of dexmedetomidine and midazolam group was significantly lower than that of the control group. T2, T5, dexmedetomidine group was slightly higher than midazolam group, P 0.05.
There was no significant difference in VAS score between the three groups at T0, but significant difference at T1-T5. The analgesic score of the two experimental groups was significantly lower than that of the control group. At T3, dexmedetomidine group was lower than midazolam group, P = 0.047.
There was no respiratory depression in the control group, and there was no difference among the three groups at T0. There was no difference between the two experimental groups at T1-T4 and the control group at P 0.01.T5. Midazolam group was slightly higher than dexmedetomidine group at P 0.05.T1-T3.
The control group was relatively poor.
In the side effects, the incidence of hypertension and tachycardia in the control group was higher than that in the control group (P 0.01).
Conclusion:
Compared with midazolam, dexmedetomidine has a certain analgesic effect, slight respiratory depression and more stable hemodynamics.
【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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