右美托咪定预先给药对青年与老年患者全身麻醉的影响

发布时间：2018-06-29 22:05

本文选题：右美托咪定(DEX) + 预先给药　；参考：《苏州大学》2015年硕士论文

【摘要】：目的比较右美托咪定预先给药对青年和老年病人全身麻醉期间丙泊酚用量、麻醉诱导和苏醒时间、血流动力学及不良反应的影响。方法择期全麻下行甲状腺切除术青年患者(20~39岁)40例,老年患者(66~80岁)40例,ASAⅠ~Ⅱ级。依据预先给药(右美托咪定或生理盐水)不同,随机分为青年右美组,青年对照组,老年右美组,老年对照组,每组各20例。于全麻诱导前10min,青年右美组和老年右美组泵注0.5ug/kg右美托咪定,青年对照组和老年对照组泵注等量生理盐水。四组患者采用相同麻醉方法,术中根据脑电双频指数值(BIS)调节丙泊酚血浆靶控浓度,维持BIS值在45±5。记录入室(T0)、诱导前(T1)、诱导后(T2)、插管时(T3)、切皮时(T4)、切皮后30min(T5)、术毕(T6)、拔管时(T7)的心率(HR)、收缩压(SBP)、舒张压(DBP);记录T2~T6各时点丙泊酚血浆靶控浓度(Cp);记录丙泊酚诱导用量、丙泊酚总量、麻醉诱导时间及苏醒时间;记录术后24h的疼痛评分、镇静评分及恶心呕吐评分。结果1.血浆靶控浓度:相同年龄段组内比较,青年对照组明显高于青年右美组,老年对照组明显高于老年右美组(P0.05);不同年龄段组间比较,老年右美组明显低于青年右美组(P0.05),老年右美组、老年对照组明显低于青年对照组(P0.05);2.丙泊酚用量:相同年龄段组内比较,青年对照组丙泊酚诱导量与总量均明显大于青年右美组,老年对照组丙泊酚诱导量与总量均明显大于老年右美组(P0.05);不同年龄段组间比较,老年右美组丙泊酚诱导量与总量均明显小于青年右美组,老年对照组的丙泊酚诱导量明显大于青年右美组,总量明显小于青年右美组(P0.05);老年右美组、老年对照组丙泊酚诱导量与总量均明显小于青年对照组(P0.05);3.血流动力学:青年对照组、老年对照组的HR、SBP、DBP在插管时(T3)、切皮时(T4),拔管时(T7)与诱导后(T2)相比均明显升高(P0.05);青年右美组的HR、SBP、DBP在拔管时(T7)与诱导后(T2)相比明显升高(P0.05)4.诱导时间:相同年龄段组内比较,青年对照组诱导时间明显长于青年右美组(P0.05),老年对照组诱导时间明显长于老年右美组(P0.05);不同年龄段组间比较,老年对照组诱导时间明显长于青年右美组(P0.05),老年右美组明显短于青年右美组(P0.05);老年右美组和老年对照组诱导时间均明显短于青年对照组(P0.05);其中老年右美组诱导时间最短,青年对照组诱导时间最长。5.苏醒时间:老年组苏醒时间明显长于青年组(P0.05)。6.术后24h VAS评分、Ramesay评分及恶心、呕吐评分:四组患者未出现明显差异,无统计学意义(P0.05)。7.不良反应:未出现严重心动过缓、低血压、寒战、术后谵妄及术中知晓。结论1.相同剂量右美托咪定对不同年龄患者其量效不同,老年患者使用右美托咪定比青年患者更能节约丙泊酚的用量。2.右美托咪定预先给药可使全麻患者血流动力学相对平稳,老年患者更为显著。3.右美托咪定预先给药可明显缩短全麻诱导时间,老年患者更为显著。
[Abstract]:Objective to compare the effects of propofol dosage, anesthesia induction and awakening time, hemodynamics and adverse reactions during general anesthesia in young and elderly patients. Methods 40 young patients (20~39 years old), 40 elderly patients (66~80 years old), ASA I ~ II. Metomomidin or saline) were divided randomly into young right beauty group, young control group, elderly right beauty group, aged control group, 20 cases in each group. Before induction of general anesthesia, 10min, young right beauty group and old right American group pump 0.5ug/kg right metoimidin, young control group and elderly control group. The four groups were treated with the same anesthesia. During the operation, the target control concentration of propofol was adjusted according to the bispectral index (BIS) value (BIS), and the BIS value was recorded in the chamber (T0), before induction (T1), after induction (T2), in intubation (T3), in the peel (T4), 30min (T5) after the incision, after the operation (T6), and in the extubation (HR), systolic pressure and diastolic pressure. Target control concentration (Cp); record propofol induction dosage, total propofol total, anesthesia induction time and awakening time; record the pain score of 24h, sedation score and nausea and vomiting score after operation. Results 1. plasma target control concentration: compared with the same age group, the young control group was significantly higher than the young right group, the elderly control group was significantly higher than the elderly right beauty. Group (P0.05); the comparison between different age groups, the elderly right beauty group was significantly lower than the young right group (P0.05), the elderly right beauty group, the elderly control group was significantly lower than the young control group (P0.05); 2. propofol dosage: the same age group, the young control group of propofol induced and the total amount were significantly greater than the young right group, the elderly control group propofol. The induction quantity and total amount were significantly greater than that of the elderly right group (P0.05). The propofol induction volume and total amount of the elderly right beauty group were significantly smaller than that of the young right group. The propofol induction in the elderly control group was significantly greater than that in the young right group, the total amount was significantly smaller than that in the young right group (P0.05), the elderly right beauty group and the elderly control group propos The phenol induction and total amount were significantly lower than that of the young control group (P0.05); 3. hemodynamics: the young control group, the HR, SBP, DBP in the aged control group (T3), the skin cutting (T4), the extubation (T7) and the induction (T2) significantly increased (P0.05); the HR, SBP, and DBP in the right group were significantly higher than the inducement (T2) 4.. Induction time: in the same age group, the induction time in the young control group was significantly longer than that in the young right group (P0.05), and the induction time of the elderly control group was significantly longer than that of the elderly right group (P0.05), and the induction time of the elderly control group was significantly longer than that of the right beauty group of Yu Qing years (P0.05), and the elderly right group was significantly shorter than the young right group (P 0.05): the induction time of the elderly right group and the elderly control group was significantly shorter than that of the young control group (P0.05). The induction time of the elderly right group was the shortest and the longest.5. awakening time in the young control group: the awakening time of the elderly group was longer than that of the young group (P0.05).6. after the 24h VAS score, the Ramesay score and nausea and vomiting score: the four groups of patients. There was no significant difference, no statistically significant (P0.05).7. adverse reactions: no severe bradycardia, hypotension, chills, postoperative delirium, and intraoperative awareness. Conclusion 1. the same dose of dexmedetomidin has different dose effects on patients of different ages. Right metomomidin can save propofol more than young patients for.2. right metoprolol. Pre administration of imidine can make the hemodynamics of the patients with general anesthesia relatively stable, and the elderly patients with.3. right metomomidine can significantly shorten the induction time of general anesthesia, and the elderly patients are more significant.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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