右美托咪定用于女性患者的有效镇静剂量研究

发布时间：2018-12-18 21:20

【摘要】：下肢手术和下腹部手术多选择在椎管内麻醉下完成。手术过程中患者始终处于清醒状态,容易出现精神紧张和焦虑。尤其对于剖宫产产妇,其不仅对手术产生恐惧和焦虑,还要时刻关注胎儿。在胎儿娩出后,产妇更加容易出现情绪激动和交感神经兴奋,并且胎儿娩出后常需使用缩宫素,能够进一步影响产妇,加重应激反应。右美托咪定作为一种新型、高选择性的α2受体激动剂,具有催眠、镇静、镇痛和抗焦虑等作用,能够有效减少或消除不良情绪和应激反应。年龄是影响药物药代动力学和药效动力学的重要因素之一,患者对药物的敏感性随年龄增长而增加。目前有关右美托咪定用于女性患者的有效镇静剂量研究较少,所以本研究旨在探讨年龄对女性患者右美托咪定有效镇静量效关系的影响以及分娩后产妇和非妊娠妇女右美托咪定有效镇静剂量的差异。目的一、探讨年龄因素对女性患者单次泵注右美托咪定有效镇静量效关系的影响。二、探讨分娩后产妇和非妊娠妇女右美托咪定有效镇静剂量的差异。方法选取腰硬联合麻醉下行下肢手术女性患者,根据年龄划分为3组,Y组(20～35岁)、M组(40～60岁)和O组(65～79岁)。选取腰硬联合麻醉下行剖宫产产妇为产妇组,非妊娠妇女患者行下腹部手术为非妊娠妇女组。产妇组待胎儿和胎盘娩出后,其他各组在确定麻醉平面后即可开始单次恒速泵注右美托咪定15min。每一例患者的给药剂量由改良二阶段序贯法确定。通过第二阶段转折点中点的均值计算各组右美托咪定有效镇静的半数有效剂量(ED50)。同时通过Probit分析法计算各组右美托咪定有效镇静的ED50、95%有效剂量(ED95)及其95%置信区间(CI)。结果Y组、M组和O组右美托咪定有效镇静的ED50分别为(0.96±0.35)μg/kg、(0.99±0.35)μg/k 和(0.68±0.46)μg/kg。使用 Probit 分析法计算 Y 组、M 组和 O组ED50及其95%CI分别为 0.98(0.93～1.03μg/kg)、0.96(0.92～1.00μg/kg)和0.66 μg/kg(0.63～0.69 μg/kg);ED95 及其 95%CI 分别为 1.13 μg/kg(1.06～1.30μg/kg),1.11 μg/kg(1.05～1.26 μg/kg)和 0.76 μg/kg(0.72～0.87 μg/kg)。产妇组和非妊娠妇女组右美托咪定有效镇静的ED50分别为(1.73±0.46)μg/kg和(1.03±0.46)μg/kg。使用Probit分析法计算产妇组和非妊娠妇女组右美托咪定有效镇静ED50及其 95%CI 为 1.69 μg/kg(1.61～1.79 μg/kg)和 0.98 μg/kg(0.92～1.02 μg/kg);ED95 及其 95%CI 为 1.93 μg/kg(1.82～2.39 μg/kg)和 1.11 μg/kg(1.05～1.35μg/kg)。Y组与M组的ED50差异无统计学意义(P0.0167);与Y组和M组比较,O组ED50降低(P0.0167)。产妇组ED50明显大于非妊娠妇女组(P0.05)。结论右美托咪定用于中、青年女性患者有效镇静时的ED50无差异,而老年女性患者的ED50显著小于中青年女性患者。另外,产妇所需右美托咪定有效镇静ED50明显大于非妊娠妇女。
[Abstract]:Lower limb surgery and lower abdominal surgery were performed under intraspinal anesthesia. During the operation, the patient is always awake and prone to mental stress and anxiety. Especially for cesarean section, it not only produces fear and anxiety, but also focuses on the fetus. After the delivery of the fetus, the parturient is more prone to emotional and sympathetic excitement, and the fetus often needs to use oxytocin after delivery, which can further affect the parturient and aggravate the stress response. As a novel and highly selective 伪 2 receptor agonist, dexmetidine has the effects of hypnosis, sedation, analgesia and anti-anxiety, which can effectively reduce or eliminate adverse emotions and stress reactions. Age is one of the most important factors affecting pharmacokinetics and pharmacokinetics. At present, there are few studies on the effective sedatives of dexmetidine for female patients. The purpose of this study was to investigate the effect of age on the effective sedative effect of dexmetomidine in female patients and the difference of the effective sedative dose between postpartum and non-pregnant women. Objective: to investigate the effect of age factors on the effective sedative response of dexmetidine by single pump in female patients. Second, to explore the difference of dexmetomidine effective sedatives between postpartum and non-pregnant women. Methods female patients undergoing lower extremity operation under combined spinal-epidural anesthesia were divided into three groups according to their age: group Y (20 ~ 35 years old), M group 40 ~ 60 years old) and O group (65 ~ 79 years old). Cesarean section under combined spinal-epidural anesthesia was selected as the parturient group, and non-pregnant women underwent lower abdominal surgery. After the delivery of fetus and placenta, the other groups could begin to infuse dexmetomidine for 15 mins after the anaesthesia level was determined. The dosage of each patient was determined by an improved two-stage sequential method. The half effective dose (ED50) of dexmetomidine effective sedation was calculated by the mean of the middle point of the second stage turning point. At the same time, the effective ED50,95% dose (ED95) and 95% confidence interval (CI).) of dexmetidine were calculated by Probit analysis in each group. Results the ED50 of dexmetidine in group Y, M and O were (0.96 卤0.35) 渭 g / kg, (0.99 卤0.35) 渭 g / kg and (0.68 卤0.46) 渭 g / kg, respectively. Probit analysis was used to calculate ED50 and 95%CI in group Y, M and O were 0.98 (0.93 渭 g/kg), 0.96 (0.92 渭 g/kg) and 0.66 渭 g/kg (0.63 渭 g/kg), respectively. ED95 and 95%CI were 1.13 渭 g/kg (1.06 渭 g/kg, 1.30 渭 g/kg), 1.11 渭 g/kg (1.05N 1.26 渭 g/kg) and 0.76 渭 g/kg (0.72 渭 g/kg, 0.87 渭 g/kg), respectively. The effective sedative ED50 of dexmetomidine was (1.73 卤0.46) 渭 g/kg and (1.03 卤0.46) 渭 g / kg in puerpera and non-pregnant women, respectively. Probit analysis was used to calculate the effective sedation of ED50 and its 95%CI were 1.69 渭 g/kg (1.61V 1.79 渭 g/kg) and 0.98 渭 g/kg (0.92U 1.02 渭 g/kg) in pregnant women and non-pregnant women. The ED50 of ED95 and 95%CI were 1.93 渭 g/kg (1.82 卤2.39 渭 g/kg) and 1.11 渭 g/kg (1.05 ~ 1.35 渭 g/kg). Y), respectively. There was no significant difference in ED50 between group M and group M (P0.0167). Compared with group Y and group M, ED50 in group O decreased (P 0.0167). ED50 in parturient group was significantly higher than that in non pregnant women group (P 0.05). Conclusion there is no difference in ED50 between young women and young women, but the ED50 of elderly women is significantly lower than that of young and middle-aged women. In addition, the effective sedation of ED50 by dexmetomidine was significantly higher in parturient than in non-pregnant women.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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