脑氧饱和度监测下右美托咪定对老年胸腔镜患者术后谵妄的影响

发布时间：2018-02-05 20:29

本文关键词： 脑氧饱和度右美托咪定胸腔镜手术术后谵妄 s-100β蛋白　出处：《石河子大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨脑氧饱和度监测下右美托咪定对老年胸腔镜手术患者术后谵妄的发生率和对血清s-100β蛋白的影响。为右美托咪定防治老年胸腔镜手术术后谵妄提供临床参考。方法:选取择期拟行电视胸腔镜手术的老年患者72例,年龄65~75岁,ASA分级I~Ⅱ级,性别不限。采用随机数字表法分为2组右美托咪定组(D组)和对照组(C组),每组36例。术前采用简易精神状态检查量表(mini-mental state examination,MMSE)检查,排除术前有认知功能障碍的患者。D组患者麻醉诱导前给予右美托咪定负荷剂量0.5μg/kg,输注时间15min,然后以0.3~0.5μg/kg/h持续输注,至手术结束前30min停止;C组以相同方法静脉注射等容量0.9%氯化钠注射液。分别记录2组患者入室后5min(T_0),麻醉诱导前(T_1),气管插管前(T_2),气管插管后即刻(T_3),单肺通气前(T_4),单肺通气结束时(T_5),拔管前(T_6),拔管后5 min(T_7)平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(Pulse Oxygen Saturation,SpO_2)、心电图(electrocardiogram,ECG)和脑氧饱和度(Cerebral regional oxygen saturation,rSO_2)。术中连续监测rSO_2并记录T_0~T_7各时间点数值。并计算术中rSO_2的平均值(2rSO)、术中rSO_2最小值(rSO_2min)和rSO_2较基础值下降的最大百分数(rSO_2%max)。于麻醉前5 min、术毕、术后24h、48h时分别采集静脉血测定s-100β蛋白浓度。于术后1、2、3d时采用谵妄评定方法中文修订版(Confusion Assessment Method-Chinese reversion,CAM-CR)量表对两组患者进行术后谵妄的评估。结果:D组患者中有2名发生术后谵妄,术后谵妄发生率为5%;C组患者有9名发生术后谵妄,术后谵妄发生率为25%,D组患者术后谵妄的发生率明显低于C组,差异有统计学意义(P0.05);两组患者术毕、术后24 h血清s-100β蛋白水平含量D组明显低于C组(P0.05);术毕和术后48h与麻醉前5min比较两组患者血清s-100β蛋白均明显升高(P0.05);两组rSO_2均在T_5时比T_0时下降明显且C组显著低于D组(P0.05);D组患者T_3时MAP明显低于C组(P0.05),C组患者MAP T_3时比T_0时刻明显上升(P0.05);两组患者HR在T_3时比T_0时均有明显上升(P0.05),SpO_2差异无统计学意义(P0.05)。D组患者的rSO_2较基础值下降的最大百分数(rSO_2%max)明显低于C组(P0.05);C组的rSO_2平均值显著低于D组(P0.05);rSO_2最小值差异无统计学意义。结论:右美托咪定能够降低老年胸腔镜手术患者术后谵妄的发生率及降低术后血清s-100β蛋白的水平,可以改善老年胸腔镜手术患者的脑氧代谢。
[Abstract]:Objective:. To investigate the effect of dexmetomidine on postoperative delirium and serum s-100 尾 protein in elderly patients undergoing thoracoscopic surgery under cerebral oxygen saturation monitoring. Clinical references. Methods:. A total of 72 elderly patients undergoing video-assisted thoracoscopic surgery were selected. The age of 65 ~ 75 years old patients with ASA grade I ~ II was not limited. The patients were randomly divided into two groups: right metomidine group (group D) and control group (group C). The mini-mental state examination (MMSE) was performed in 36 patients in each group before operation. Before anesthesia induction, patients in group D were treated with dexmetomidine at a dose of 0.5 渭 g / kg for 15 minutes. Then 0.3 渭 g / kg / h of 0.5 渭 g / kg / h was continuously infused and stopped 30 minutes before the end of the operation. In group C, 0.9% sodium chloride injection of equal volume was injected intravenously with the same method. The patients in two groups were recorded at 5 min after entering the room, before induction of anesthesia, before induction of anesthesia, T1T, and before tracheal intubation. Immediately after tracheal intubation, T _ 3, T _ (4), T _ (5) and T _ (6) at the end of one-lung ventilation. Mean arterial pressure MAPP, heart rate and heart rate were observed 5 min after extubation. Pulse Oxygen saturation (SPO _ 2), electrocardiogram (ECG). And cerebral oxygen saturation (Cerebral regional oxygen saturation). RSO_2 was monitored continuously during operation and the values of T0 / T _ (7) were recorded. The mean value of rSO_2 during operation was calculated (2rso). The maximum percentage of the decrease of rSO_2 and rSO_2 compared with the basic value was max.5min before anaesthesia, 24 hours after operation. The concentration of s-100 尾 protein in venous blood was measured at 48 h after operation. The delirium Assessment Method-Chinese reversion was evaluated by the Chinese version of the revised Chinese version on the 3rd day. Results two patients in group D had postoperative delirium, and the incidence of postoperative delirium was 5%. There were 9 cases of postoperative delirium in group C, the incidence of postoperative delirium in group D was significantly lower than that in group C (P 0.05). The level of serum s-100 尾 protein in group D was significantly lower than that in group C at 24 hours after operation. Compared with 5 min before anesthesia, serum s-100 尾 protein increased significantly in both groups at the end of operation and 48 hours after operation compared with 5 min before anesthesia. RSO_2 in both groups was significantly lower than that in T _ 0 at T5 and P _ (0.05) in group C was significantly lower than that in D group (P < 0.05). The level of MAP in group D was significantly lower than that in group C at the time of MAP T3 compared with that in group C (P 0.05). The HR of both groups was significantly higher than that of T _ 0 at the time of T _ 3 (P 0.05). There was no significant difference in SpO_2 between the two groups (P 0.05). The rSO_2 of group D was significantly lower than that of group C (P 0.05%) than that of group C (P < 0.05), and that of group D was significantly lower than that of group C (P < 0.05). The average value of rSO_2 in group C was significantly lower than that in group D (P 0.05). Conclusion: dexmetomidine can reduce the incidence of postoperative delirium and the level of serum s-100 尾 protein in elderly patients undergoing thoracoscopic surgery. It can improve cerebral oxygen metabolism in elderly patients undergoing thoracoscopic surgery.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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