地佐辛与右美托咪定联合丙泊酚用于宫颈锥切术麻醉效应的比较
发布时间：2018-06-07 05:38
本文选题：右美托咪定 + 地佐辛 ； 参考：《青岛大学》2017年硕士论文
【摘要】：目的:宫颈锥切手术是妇科常见的日间短小手术之一,其特点是手术时间短,刺激轻,对麻醉效果、麻醉起效时间以及苏醒时间都有较高的要求。一般丙泊酚复合舒芬太尼就能完成,但术中麻醉深度不足,往往因体动反应影响手术医生操作,麻醉过深易呈现出呼吸抑制、苏醒延迟,术后易出现疼痛反应、寒战反应、恶心呕吐等不良反应。右美托咪定(DEX,Dexmedetomidine)作为一种新型的高选择性α2肾上腺素受体激动剂,具有镇静、镇痛、抑制交感神经系统活性的作用,并且患者在术中易唤醒,其最大的特点是无呼吸抑制。地佐辛是一种强效阿片类混合受体激动药,激动k受体,对μ受体有部分激动部分拮抗的作用,可产生强效镇痛和良好镇静的作用,不易产生耐受性,呼吸抑制较轻。本实验的目的在于研究对照靶控输注丙泊酚复合右美托咪定与地佐辛进行镇痛镇静,用于宫颈锥切手术的临床可行性、安全性和不良反应的发生情况等。方法:选取我院60例拟静脉麻醉(TIVA)下择期行宫颈锥切手术的患者作为研究对象,年龄在35~45岁之间,BMI18.5~24之间,ASAI~II级,采用随机数字表法分为A(对照组)、B(实验组)两个组别。两组分别与术前10分钟静脉输注地佐辛0.1mg/kg和右美托咪定0.8μg/kg,随后给予舒芬太尼0.1μg/kg,继之启动靶控输注丙泊酚,血浆靶浓度(Cp)起始设置为1.2μg/ml,当与效应室浓度平衡2min后,以0.1μg/ml的梯度逐渐调整,直至睫毛反射消失后,开始手术。术中维持BIS在50~60之间,根据患者反应和脑电双频谱指数(BIS)的变化,调节丙泊酚靶控浓度,手术结束前5分钟停止输注丙泊酚。观察并记录(1)患者入室5min(基础值)(T0)、手术开始(T1)、手术开始10min(T2)、手术结束(T3)及意识恢复(呼之睁眼)(T4)时的平均动脉血压(MAP)、心率(HR),脉搏血氧饱和度(Sp O2)、呼吸频率(RR);(2)手术时间;丙泊酚平均效应室浓度、丙泊酚总用量;苏醒时间(停止丙泊酚输注至呼之睁眼时)及辅助用药使用情况等;(3)自主睁眼后10min Ramsay评分及术后疼痛视觉模拟评分(VAS)和麻醉满意度评分等;(4)术中及术后不良事件发生情况。结果:所有患者均能成功完成手术,两组患者的手术时间、VAS评分及麻醉满意度评分均无明显差异(P0.05)。B组丙泊酚平均效应室浓度(1.68±0.23)、总用量(149.57±9.89)、苏醒时间(4.20±0.71)、Ramsay评分(2.77±0.73)均小于A组(2.11±0.32),(168.47±8.21),(5.03±0.93)、(3.83±1.12)(P㩳0.05)。A组在T1、T2时刻MAP下降显著(P㩳0.05),B组T1时HR较T0时下降显著(P㩳0.05),其余各时间点差异均无统计学意义。B组Sp O2维持满意,A组有4例患者出现呼吸抑制,两组患者用药以后呼吸次数均减慢。B组术后不良反应发生率均小于A组(P㩳0.05)。结论:与地佐辛相比,右美托咪定应用于宫颈锥切术能更有效的维持血流动力学的稳定,减少术后不良反应的发生,但应用时应注意对心率的影响。
[Abstract]:Objective: cervical conization is one of the most common short day operations in gynecology, which is characterized by short operation time, light stimulation and high requirements for anesthetic effect, anaesthesia onset time and recovery time. General propofol combined with sufentanil can be completed, but the depth of anesthesia is insufficient during the operation, which often affects the operation of the surgeon because of the body movement reaction. The deep anesthesia is prone to respiratory inhibition, delayed recovery, postoperative pain response and shivering reaction. Adverse reactions such as nausea and vomiting. Dexmedetomidine (Dexmedetomidine), a new type of highly selective 伪 2-adrenergic receptor agonist, has the effects of sedation, analgesia and inhibition of sympathetic nervous system activity. Dizosin is a potent opioid mixed receptor stimulator, which excites k receptor, and has partial antagonistic effect on 渭 receptor, which can produce strong analgesia and good sedative effect, not easy to produce tolerance, and mild respiratory inhibition. The purpose of this study was to study the clinical feasibility, safety and adverse reactions of target controlled infusion of propofol combined with dextromidine and dizosin for analgesia and sedation. Methods: a total of 60 patients undergoing cervical conization under intravenous anesthesia in our hospital were selected as the study subjects. The patients aged between 35 and 45 years old were divided into two groups: group A (control group) and group A (control group) by random number table method. The patients aged between 35 and 45 years old were divided into two groups: ASAI 鈪，
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