右美托咪定复合氯胺酮麻醉在颈淋巴结结核手术中的应用

发布时间：2018-03-30 05:00

本文选题：右美托咪定　切入点：氯胺酮　出处：《广东医学》2017年06期

【摘要】：目的观察右美托咪定(Dex)对氯胺酮复合丙泊酚静脉全麻手术患者麻醉效果及复苏的影响。方法择期行单侧或双侧颈淋巴结结核病灶清除手术患者60例,ASAⅠ~Ⅱ级,分成Dex组(D组)和对照组(K组)。D组患者麻醉诱导前10 min给予Dex负荷剂量1μg/kg,术中以0.5μg/(kg·h)静脉泵注维持;K组患者相同方法给予相同容量生理盐水静脉注射。记录给药前(T1)、诱导前(T2)、切皮时(T3)、搔扒病灶时(T4)、手术结束时(T5)、术后清醒时(T6)手术患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏氧饱和度(Sp O2)及术中不良情况及处理;记录患者氯胺酮及丙泊酚用量及术中体动情况;记录患者手术时间、停药后意识恢复时间及定向力恢复时间;记录患者复苏期不良情况,并于患者术毕清醒时进行VAS评分,随访术中知晓情况。结果 D组患者给予Dex后,HR在T2、T3、T4、T5时降低,差异有统计学意义(P0.05),K组患者SBP、DBP、HR在诱导后T3、T4、T5时间点有上升,差异有统计学意义(P0.05);D组患者氯胺酮、丙泊酚用量及术中体动发生率明显低于K组,差异有统计学意义(P0.01);K组患者复苏期谵妄、躁动有9例,发生率为30%,疼痛(VAS4分)有8例,发生率达26.7%,而D组无一例发生躁动谵妄,疼痛(VAS4分)仅1例,发生率为3.3%(P0.01)。结论 Dex负荷量1μg/kg,术中以0.5μg/(kg·h)维持输注可使在氯胺酮复合丙泊酚静脉全麻下行颈淋巴结结核清除手术患者镇静镇痛适当,血流动力学稳定,预防复苏期躁动,不良反应较少,可适用于体表短小手术麻醉。
[Abstract]:Objective to observe the effect of dexmetomidine Dexon on anesthesia and resuscitation in patients undergoing intravenous general anesthesia with ketamine and propofol. They were divided into Dex group (group D) and control group (group K). The patients in group D were given Dex loading dose of 1 渭 g / kg 10 min before anesthesia induction, and the patients in group K received the same volume of normal saline intravenously during the operation with 0.5 渭 g/(kg 路h). Before the administration of the drug, the patients in group K received the same volume of normal saline. T1, T2, T3, T4, T5, T6), SBP, DBP, HR, SPO _ 2, SPO _ 2, SPO _ 2, SBP, DBP, SPO _ 2). The dosage of ketamine and propofol and the intraoperative body movement were recorded, the time of operation, the time of consciousness recovery and the recovery of orientation after withdrawal were recorded. The adverse situation of the patients during the resuscitation period was recorded, and the VAS score was scored when the patients were awake after operation. Results the HR of group D after Dex was significantly lower than that of group T _ (2) T _ (3) and T _ (4) T _ (5), and the difference was statistically significant (P < 0.05). There was a significant increase in Dex _ (DBP) HR at the time point of T _ (3) T _ (4) T _ (4) T _ (5) after induction, and there was significant difference in ketamine in group D (P _ (0.05)). The dosage of propofol and the incidence of body movement in group K were significantly lower than those in group K, and the difference was statistically significant (P 0.01). There were 9 cases of restlessness (30 cases, VAS4 score) in group D and 8 cases (incidence of 26.7%), while no case of delirium in group D occurred restlessness. There was only one patient with pain and VAS4 score, the incidence rate was 3.3g / kg. Conclusion Dex loading of 1 渭 g / kg and intraoperative infusion of 0.5 渭 g/(kg / kg can make the sedation, analgesia and hemodynamics stable in patients undergoing general anesthesia with ketamine combined with propofol for cervical lymph node tuberculosis removal. Prevention of restlessness during resuscitation, less adverse reactions, can be used in short surface surgery anesthesia.
【作者单位】：广州市胸科医院麻醉科;
【分类号】：R614

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