氟马西尼对丙泊酚复合舒芬太尼全身麻醉患者血浆中orexin-A的影响

发布时间：2018-03-21 03:42

本文选题：氟马西尼　切入点：丙泊酚　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过观察氟马西尼对丙泊酚复合舒芬太尼全身麻醉患者恢复期血浆中orexin-A浓度水平的影响,来探讨orexin-A是否与氟马西尼的促进麻醉苏醒作用相关。方法选择需要全凭静脉全身麻醉行择期腹腔镜下全子宫切除术或者子宫肌瘤剥除术的患者,共40例,ASA为I~II级,随机分为实验组(氟马西尼组)和对照组(生理盐水组),每组各20例。患者入室后建立上肢静脉通路,给予常规补液,并行桡动脉穿刺置管术,连续监测袖带血压(NBP)、动脉血压(ABP)、心率(HR)、心电图(ECG)、血氧饱和度(Sp O2)、脑电双频指数值(BIS)。麻醉诱导时依次静脉注射丙泊酚1~1.5mg/kg,舒芬太尼0.32~0.5μg/kg以及顺苯磺酸阿曲库铵0.3mg/kg,3分钟后行气管插管术,连接麻醉机行机控呼吸。术中丙泊酚以4~10mg·kg-1·h-1持续泵注,使BIS值控制在50~60,根据手术情况,间断追加顺苯磺酸阿曲库铵以及舒芬太尼。距离手术结束约30分钟时,停止追加顺苯磺酸阿曲库铵及舒芬太尼,丙泊酚在关腹后停止泵注。关腹后实验组按0.007mg/kg静脉注射氟马西尼,对照组亦在关腹后给予同等剂量的生理盐水。在给药(氟马西尼或生理盐水)前(T0)、给药后5min(T1)、给药后15min(T2)、给药后30min(T3)四个时间点,分别抽取桡动脉血3.0ml,离心后采用ELISA检测血浆中orexin-A浓度。记录患者呼唤时睁眼时间、拔出气管插管时间以及术后并发症发生率。结果氟马西尼组(F组)与生理盐水组(N组)比较,给药后患者BIS值升高迅速,并且患者睁眼时间及拔出气管插管时间均缩短,P0.05;两组患者T1、T2、T3的orexin-A浓度比T0的orexin-A浓度高,P0.05,且F组在T1、T2、T3三个时间点的orexin-A浓度均较N组高,P0.05;术后F组与N组比较,两组患者发生烦躁、寒战、恶心等并发症的差别没有统计学意义,p0.05。结论氟马西尼可产生促醒作用,使手术患者的麻醉恢复时间缩短;在麻醉恢复期,氟马西尼可提高复合使用丙泊酚和舒芬太尼进行全身麻醉的患者血浆中的orexin-A浓度,这有可能是氟马西尼产生促醒作用的机制之一。
[Abstract]:Objective to observe the effect of flumazenil on plasma orexin-A concentration in patients with general anesthesia of propofol and sufentanil. To investigate whether orexin-A is related to the effect of flumacini on anaesthesia recovery. Methods A total of 40 patients were selected for elective laparoscopic hysterectomy or hysteromyomectomy with total intravenous general anesthesia. The patients were randomly divided into experimental group (flumacini group) and control group (normal saline group, 20 cases in each group). Continuous monitoring of cuff blood pressure (NBPU), arterial blood pressure (ABP), heart rate (HRG), electrocardiogram (ECG) ECGG, blood oxygen saturation (SPO _ 2), bispectral index (BISS). Propofol (11.5 mg / kg), sufentanil (0.320.5 渭 g / kg) and ammonium sulfosulfonate (0.3 mg / kg) were injected intravenously during anesthesia induction, and endotracheal intubation was performed 3 minutes later. During the operation, propofol was continuously pumped with 4U 10 mg 路kg-1 路h -1 to control the BIS value at 50 掳60. According to the operation conditions, the sufentanil and atracurium benzenesulfonate were added intermittently. About 30 minutes from the end of the operation, The injection of propofol was stopped after the abdominal closure. The experimental group was injected with flumazenil at 0.007 mg / kg intravenously after abdominal closure. The control group was also given the same dose of normal saline after abdominal closure. There were four time points before administration (flumacini or normal saline), 5 min after administration, 15 min after administration, 15 min after administration, 30 min after administration and 30 min after administration. Radial artery blood was drawn from 3.0 ml, and the plasma orexin-A concentration was measured by ELISA after centrifugation. The time of eye opening, tracheal intubation and postoperative complications were recorded. Results the results were compared with those of normal saline group (n group) and flumazenil group (F group). The BIS value of the patients increased rapidly after administration. The time of eye opening and tracheal intubation was shortened by P0.05.The orexin-A concentration of T1T _ 2T _ 3 in two groups was higher than that of orexin-A of T _ 0, and the orexin-A concentration of group F was higher than that of group N at three time points of T _ 1 and T _ 2T _ 3.Compared with that of group N, the patients in group F had agitation. There was no significant difference in complications such as shivering, nausea and other complications (p 0.05). Conclusion flumacini can promote the recovery of anesthesia and shorten the recovery time of the patients. Flumazenil can increase the concentration of orexin-A in the plasma of patients under general anesthesia with propofol and sufentanil, which may be one of the mechanisms of the arousal effect of flumazenil.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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