右美托咪定与丙泊酚对应用蛛网膜下腔阻滞麻醉行下腹部手术患者适度镇静效果的比较

发布时间：2018-04-14 18:08

本文选题：右美托咪定 + 丙泊酚　；参考：《吉林大学》2017年硕士论文

【摘要】：研究目的:比较右美托咪定与丙泊酚在应用蛛网膜下腔阻滞麻醉行下腹部手术中患者镇静效果。研究方法:将ASA分级为Ⅰ级或Ⅱ级在蛛网膜下腔阻滞下行下腹部手术患者80例随机分为2组,应用右美托咪定辅助镇静的D组和丙泊酚辅助镇静的P组各40例,D组在麻醉平面固定后以1ug·kg-1·h-1的初始速度泵注10min,然后以0.5ug·kg-1·h-1的速度维持;P组在麻醉平面固定后以6mg·kg-1·h-1的初始速度泵注10min,然后以2.5mg·kg-1·h-1的速度维持。所有患者均采用标准化方案,不使用术前用药,患者术中有任何疼痛或不适均需与麻醉医生沟通。记录患者术前人口统计学资料和术后恢复情况,应用OAA/S镇静评分对两组患者进行观察,记录两组患者在输注药物即刻及之后每间隔5min的HR、MAP、OAA/S镇静评分至手术结束,并记录两组患者术中牵拉反应以及不良反应的发生情况。研究结果:1.两组患者术前人口统计学资料无明显差异,但术后恢复情况中有效镇痛时间D组(179.50±8.93 min)显著高于P组(151.30±8.29 min)(P0.05);D组停药到OAA/S评分恢复到4分及以上的时间(19.40±2.48 min)明显长于P组(13.93±1.99 min)(P0.05)。2.D组与P组两组患者OAA/S镇静评分基础值差异无统计学意义(P0.05)。泵注药物后D组与P组均能达到适度镇静,但D组患者达到目标镇静深度所需时间较P组长,D组在术中维持的镇静深度较P组深,差异有统计学意义(P0.05)。3.D组与P组两组患者心率与平均动脉压的基础值差异无统计学意义(P0.05);泵注药物后D组心率较P组低,差异有统计学意义(P0.05),P组平均动脉压较D组低,差异有统计学意义(P0.05)。4.两组患者均未出现严重的牵拉反应,抑制牵拉反应的效果显著。D组抑制牵拉反应效果为优的比例显著高于P组,P组抑制牵拉反应效果为良的比例显著高于D组,差异有统计学意义(P0.05)。5.两组患者恶心呕吐、心动过缓、低血压、寒战不良反应的发生率差异无统计学意义(P0.05)。P组呼吸抑制的发生率显著高于D组,差异有统计学意义(P0.05)。结论:右美托咪定用于蛛网膜下腔阻滞麻醉行下腹部手术中的镇静效果优于丙泊酚,循环及呼吸抑制作用轻微。右美托咪定与丙泊酚相比能够有效的抑制牵拉反应,显著延长蛛网膜下腔阻滞的时间。
[Abstract]:Objective: To compare dexmedetomidine anesthesia sedation effect for lower abdominal surgery with application of propofol in subarachnoid anesthesia. Methods: ASA grade was grade I or II in subarachnoid anesthesia in abdominal surgery under 80 cases of patients were randomly divided into 2 groups, D group and propofol sedation application right dexmedetomidine sedation in the P group with 40 cases in each group, D group in the level of anesthesia after fixation with 10min initial speed of infusion 1ug - kg-1 - H-1, and 0.5ug kg-1 to maintain the speed of H-1; P in group 10min after anesthesia fixed initial infusion speed 6mg - kg-1 - H-1. Then in order to maintain 2.5mg kg-1 H-1 speed. All the patients were treated with the standard scheme, without the use of preoperative medication, patients who have any pain or discomfort are required to communicate with the anesthesiologist. Record the preoperative demographics and postoperative recovery, OAA/S sedation assessment Divided into two groups of patients were observed in two groups were recorded every 5min in the infusion of the drug immediately and after each HR, MAP, OAA/S sedation score to the end of surgery, and recorded the stretch reaction and the adverse reaction of the patients in the two groups. Results: no significant difference between the 1. groups of patients in the previous two statistical data, but the postoperative recovery in effective analgesia time D group (179.50 + 8.93 min) was significantly higher than that of group P (151.30 + 8.29 min) (P0.05); D group to return to the discontinuation of OAA/S score 4 points and over time (19.40 + 2.48 min) was longer than that of group P (13.93 + 1.99 min) (P0.05).2.D group and P group, two groups of patients with OAA/S sedation score based value difference (P0.05). After drug infusion of D group and P group could achieve moderate sedation, but D patients reached the target sedation time is P group, D group to maintain the depth of sedation during operation compared with P group, the difference was statistically Statistically significant (P0.05) of.3.D group and P group of two groups of patients with heart rate and mean arterial blood pressure was no significant difference (P0.05); group D after drug infusion rate was lower than that of P group, the difference was statistically significant (P0.05), mean arterial pressure in P group was lower than that of D group, the difference was statistically significant (P0.05).4. two group of patients without severe stretch reaction, the effect of inhibition of traction reaction in.D group significantly inhibition of traction reaction results were excellent ratio was significantly higher than P group, P group, inhibition of traction reaction effect is good the proportion was significantly higher than D group, the difference was statistically significant (P0.05.5. two) group of patients with nausea and vomiting, bradycardia, hypotension, adverse reaction incidence of shivering was no statistically significant difference (P0.05) the incidence of respiratory depression in group.P was significantly higher than that of D group, the difference was statistically significant (P0.05). Conclusion: dexmedetomidine for subarachnoid block anesthesia for abdominal surgery in the town The static effect is superior to propofol, and the inhibition of circulation and respiration is slight. Dexmedetomidine can effectively inhibit the traction reaction and prolong the time of subarachnoid block compared with propofol.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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