盐酸右美托咪定在胸主动脉瘤介入手术中的应用

发布时间：2019-05-03 20:00

【摘要】：目的: 胸主动脉瘤介入手术中，由于患者意识完全清醒，当局麻部位出现镇痛不全时，导致其紧张、焦虑甚至恐惧等，临床表现为心率加快、血压升高,增加心肌耗氧量，从而不利于心肌细胞氧供需的平衡，因此易出现心绞痛，甚至心肌梗死等严重并发症。方法：选择拟行胸主动脉瘤介入手术患者60例，采用随机双盲的方法分为三组（A：右美托咪定组，B：咪达唑仑组，C：对照组）,每组患者20例。A组泵注右美托咪定负荷剂量为1μg/kg，匀速输注15分钟后负荷量泵注完毕，以0.1-0.7μg/kg/h的剂量维持泵注；B组患者静注咪达唑仑注射液30-40μg/kg；C组患者静脉给予生理盐水5ml。分别观察入手术室时、用药后5min、局麻置管时、手术中、手术结束后的血压、心率、血氧饱和度,并记录患者的镇静程度,遗忘程度以及术后的心理状况；记录在整个手术过程中出现的不良反应，即：心动缓慢(心率50次/min)，心动过速(心率100次/min)，高血压(收缩压170mmHg)，低血压(收缩压85mmHg)，呼吸抑制(呼吸频率8次/min)，恶心呕吐、过敏反应等其他特殊不良反应。结果：三组组患者年龄、体重、身高、性别差异均无统计学意义，三组在任一时刻的SPO2和呼吸频率没有显著差异, P0.05。所有患者的SPO2均95%,所有患者在整个过程中的呼吸抑制评分均在1-3分。 A组、B组与C组相比较，在给药后5min、局麻置管时及手术中，平均动脉压均低于C组，差异具有显著性（P0.05）；A组与B组相比，局麻时A组平均动脉压低于B组，差异具有显著性（P0.05）。镇静评分： A组、B组与C组相比有非常显著的差异,（P 0.01）；A组与B组相比，无显著性差异（P0.05）。术中合作度评级：A组、B组与C组相比有非常显著的差异,（P 0.01）；A组与B组相比，无显著性差异（P0.05）。术后患者对术中镇痛、镇静效果满意度评分，A组、B组与C组相比较，差异有统计学意义（P0.05)，A组与B组比较，差异无统计学意义（P0.05)。遗忘程度比较，A组、B组与C组相比较，差异有统计学意义（P0.05)，A组与B组比较，差异有统计学意义（P0.05) 不良反应的发生情况,并发高血压者：A组、B组与C组相比，，差异具有显著性，（P0.01）；并发心动过速者：A组、B组与C组相比，差异具有显著性，（P0.01）。在心动过缓,低血压,呼吸抑制,恶心呕吐,过敏反应几个方面没有显著差异。结论：右美托咪定与咪达唑仑相比，在局部麻醉胸主动脉瘤介入手术时可以使患者的血液动力学更稳定，不良反应发生率更少。
[Abstract]:Objective: during the interventional operation of thoracic aortic aneurysm, due to the complete consciousness of the patient and the inadequacy of analgesia in the anesthetic area of the authorities, it leads to tension, anxiety and even fear. The clinical manifestations are as follows: the heart rate is increased, the blood pressure is elevated, and so on. The increase of myocardial oxygen consumption is not conducive to the balance of oxygen supply and demand of myocardial cells, so angina pectoris, even myocardial infarction and other serious complications are easy to occur. Methods: sixty patients with thoracic aortic aneurysm undergoing interventional operation were randomly divided into three groups (A: right metometomidine group, B: midazolam group, C: control group), and the patients were randomly divided into three groups (A: right metametramine group, B: midazolam group, C: control group). There were 20 patients in each group. In group A, the dose of right metomidate was 1 渭 g / kg, for 15 minutes, and the dose of 0.1-0.7 渭 g / kg/h was maintained. Group B received intravenously midazolam injection (30-40 渭 g / kg;C) intravenously with normal saline (5 ml). The blood pressure, heart rate, blood oxygen saturation after operation were observed at 5 min after medication and local anaesthesia, and the degree of sedation, amnesia and psychological state after operation were recorded. Adverse reactions were recorded throughout the operation, namely, slow heart rate (heart rate 50 beats / min), tachycardia (heart rate 100 beats / min), hypertension (systolic blood pressure 170mmHg), hypotension (systolic blood pressure 85mmHg). Respiratory inhibition (respiratory rate of 8 / min), nausea, vomiting, anaphylaxis, and other specific adverse reactions. Results: there was no significant difference in age, weight, height and sex among the three groups. There was no significant difference in SPO2 and respiratory rate among the three groups at any time, P 0.05. All patients had 95% SPO2, and all patients had a respiratory inhibition score of 1? 3. Compared with group C, the mean arterial pressure in group A and group B was significantly lower than that in group C at 5 minutes after administration (P0.05), and the mean arterial pressure was significantly lower in group A and group B than in group C (P0.05). Compared with group B, the mean arterial pressure in group A was significantly lower than that in group B during local anesthesia (P0.05). Sedation score: there was no significant difference between group A, group B and group C in, (P 0.01); A group and B group (P0.05). Intraoperative cooperation rating: there was no significant difference between group A, group B and group C in, (P 0.01); A group and B group (P0.05). Postoperative analgesia, sedation effect satisfaction score, A group, B group and C group, the difference was statistically significant (P0.05), A group and B group, the difference was not statistically significant (P0.05). The degree of amnesia, A group, B group and C group, the difference was statistically significant (P0.05), A group and B group, the difference was statistically significant (P0.05) the occurrence of adverse reactions, patients with hypertension: group A, P < 0.05, P < 0.05). There was significant difference between group B and group C (P0.01). Patients with tachycardia: group A, group B and group C, the difference was significant (P0.01). There was no significant difference in bradycardia, hypotension, respiratory inhibition, nausea and vomiting, anaphylaxis. Conclusion: compared with midazolam, right metomidine can make the hemodynamics more stable and the incidence of adverse reactions less in patients with thoracic aortic aneurysm under local anesthesia.
【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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