右美托咪定在腰硬联合麻醉中对老年患者的作用研究

发布时间：2018-03-03 07:10

本文选题：右美托咪定　切入点：咪达唑仑　出处：《河南科技大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对比右美托咪定与咪达唑仑对老年患者在腰硬联合麻醉中的循环、镇静效应以及是否会出现呼吸功能受抑制等方面的影响,研究右美托咪定在用于老年患者腰硬联合麻醉中辅助镇静的有效性及安全性。方法:选取河南科技大学第一附属医院和南阳医专第一附属医院2015年6月~2016年6月择期行下腹部、下肢手术且采用腰硬联合麻醉方式的老年患者80例,男45例,女35例,平均年龄(72.42±5.83)岁,ASAⅠ~Ⅰ级。进入实验的老年患者按随机数字表法分为对照组和实验组,分别为咪达唑仑组(M组)和右美托咪定组(D组),每组各40例。麻醉效果确切后,M组患者10min内予以咪达唑仑以0.05mg/kg静脉泵入,之后以0.1mg/kg/h的速度静脉泵注维持,D组患者在10min内给予右美托咪定0.5μg/kg静脉泵入,之后以浓度0.3μg/kg/h持续静脉泵注。对2组患者给药前(T0)、给药后10min(T1)、20min(T2)、30min(T3)、60min(T4)的有创平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、改良警觉/镇静视觉评分(OAA/S评分)和血氧饱和度(SpO2)进行观察比较,并且把这2组病人术中不良反应的发生情况和术后24h随访病人对麻醉手术操作的遗忘程度详细的记录下来。结果:与T0进行对比,发现T2~T4时M组患者的MAP显著降低(P0.05),且显著低于D组(P0.05);T1~T4时,D组与M组病人的HR进行对比,差异没有统计学意义(P0.05);与T0相比较,T2~T4时M组患者RR和SPO2均明显下降(P均0.05),与D组比较,差异有统计学意义(P0.05);与T0相比较,T1~T4时2组患者OAA/S评分均显著下降(P0.05),且T2~T4时M组明显低于D组(P0.05);D组病人不良反应发生率与M组进行对比,D组明显比M组少(P0.05);M组患者顺行性遗忘率情况与D组进行对比,差异没有统计学意义(P0.05)。结论:1.D组患者与M组进行对比,D组患者呼吸抑制作用相对较弱,血流动力学更加稳定,不良反应的发生率比M组要少的多。2.右美托咪定能够起到良好的镇静作用,患者在镇静状态下唤醒也比较容易,对老年患者呼吸功能的影响也比较小,能够降低寒战的发生几率,并且能够明显减少呛咳、恶心、呕吐、体动、抑制呼吸、气道梗阻等不良反应的发生次数,是一种比较理想的静脉镇静药。
[Abstract]:Aim: to compare the effects of dexmetidine and midazolam on circulation, sedation and respiratory inhibition in elderly patients under combined spinal-epidural anesthesia. To study the efficacy and safety of dexmetomidine in the treatment of combined spinal-epidural anesthesia in elderly patients. Methods: the first affiliated Hospital of Henan University of Science and Technology and the first affiliated Hospital of Nanyang Medical College from June 2015 to June 2016 were selected for lower abdomen. Eighty patients (45 males and 35 females) undergoing lower limb surgery with combined spinal-epidural anesthesia, with an average age of 72.42 卤5.83 years old, were divided into two groups: control group and experimental group. Midazolam group (group M) and dexmetomidine group (group D, n = 40) were given midazolam (0.05 mg / kg) intravenously in 10 minutes after anaesthesia. Then the patients in group D were given dexmetomidine 0.5 渭 g / kg intravenously for 10 minutes at a velocity of 0.1 mg / kg / h. The mean arterial pressure (MAPV), heart rate (HRV), respiratory frequency (RRRR), improved alertness / sedation visual score (OAAS) and blood oxygen saturation (SPO _ 2) were observed and compared in the two groups before and 10 min after administration. The incidence of adverse reactions during operation and the degree of amnesia during 24 hours follow-up were recorded in detail. Results: compared with T0. It was found that the MAP of M group was significantly lower than that of group D (P 0.05), and significantly lower than that of group D (P 0.05), and the HR of group D and M was not significantly different from that of group M, and the RR and SPO2 of group M were significantly lower than those of group D (P < 0.05), and that of group D were significantly lower than that of group D (P < 0.05). Compared with T0, the OAA/S scores of both groups were significantly decreased, and the incidence of adverse reactions in group M was significantly lower than that in group D (P 0.05) and the incidence of adverse reactions in group D was significantly lower than that in group M (P 0.05) than that in group M (P 0.05), and the incidence of adverse reactions in group D was significantly lower than that in group M (P < 0.05), and the incidence of adverse reactions in group D was significantly lower than that in group D (P < 0.05), and the incidence of adverse reactions in group D was significantly lower than that in group M. The antegrade amnesia rate was compared with that in group D. Conclusion compared with M group, the respiratory inhibition effect of D group is relatively weak and the hemodynamics is more stable. The incidence of adverse reactions was much lower in group M than in group M. Dexmetomidine could play a good sedative effect, and it was easier for patients to wake up under sedation, and had little effect on respiratory function in elderly patients. It can reduce the incidence of shivering, and can obviously reduce the occurrence times of cough, nausea, vomiting, body movement, respiratory suppression, airway obstruction and other adverse reactions. It is an ideal drug for intravenous sedation.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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