地塞米松对腹腔镜下直肠癌根治术术后恢复期Narcotrend指数及S100β蛋白的影响

发布时间：2018-04-05 20:13

  本文选题：腹腔镜手术　切入点：头低脚高位　出处：《大连医科大学》2017年硕士论文

【摘要】：目的研究地塞米松对头低位手术术后恢复期苏醒质量的影响。在麻醉苏醒期应用Narcotrend监测对患者的意识恢复情况作出客观评价。研究方法1研究对象经患者及家属同意并通过医学伦理委员会批准,选择大连市中心医院2015年4月至2016年11月期间,于全凭静脉麻醉下行腹腔镜辅助下直肠癌根治术患者58例,随机分成两组,对照组(A组)和地塞米松组(B组),每组29名患者(n=29)。2研究方法患者入室后常规开放静脉通路,监测无创血压,心率,指脉氧饱和度,Narcotrend麻醉深度监测,桡动脉穿刺置管监测动脉血压。根据患者体重常规麻醉诱导。术中根据Narcotrend监测数值调整丙泊酚靶浓度,使Narcotrend监测数值保持于D水平,于头低位30分钟后两组分别输注生理盐水2毫升(A组),10毫克地塞米松2毫升(B组),必要时追加罗库溴铵30毫克,手术结束前30min输注特耐40毫克,缝皮前停止输注所有的药物。3观察与记录3.1 一般资料:性别,年龄,ASA分级,体重,头低位时间,术中输液量,尿量,术后8小时患者血清S100β蛋白水平。3.2记录两组患者术后恢复期Narcotrend指数由D变为A的时间,有无苏醒期躁动。3.3记录两组患者术后恢复期GCS评分。4统计学分析采用SPSS12.0软件进行统计学分析。计量资料均以x ±SD表示,采用t检验进行组间差异的显著性检验;计数资料采用X2检验。P0.05认为有统计学差异。结果1两组患者的一般情况,如性别,年龄,ASA分级,体重,手术时间,头低位时间,术中补液量,尿量,组间比较无统计学差异。2两组患者术后恢复期Narcotrend指数由D变为A所需时间,组间比较差异有统计学意义。地塞米松组术后GCS评分较对照组高。3患者术后8小时血清S100 β蛋白浓度,组间比较无统计学意义。结论1在腹腔镜辅助直肠癌根治术中应用地塞米松,可以提高麻醉苏醒质量。2在麻醉恢复期应用Narcotrend监测,可以有效,客观的反映患者意识状况,缩短麻醉恢复时间。
[Abstract]:Objective to study the effect of dexamethasone on recovery quality after head-low operation.The consciousness recovery of patients was evaluated objectively by Narcotrend monitoring during anaesthesia recovery period.Methods 1 58 patients undergoing laparoscopic radical resection of rectal cancer were selected from April 2015 to November 2016 in Dalian Central Hospital with the consent of the patients and their families and the approval of the Medical Ethics Committee.Two groups were randomly divided into two groups (control group A) and dexamethasone group B (29 patients in each group). The patients in each group were studied by routine opening of venous pathway after entering the room to monitor noninvasive blood pressure, heart rate, oxygen saturation of finger pulse and Narcotrend anesthetic depth.Radial artery puncture was used to monitor arterial blood pressure.Induction of routine anesthesia according to the patient's weight.During the operation, the target concentration of propofol was adjusted according to the value of Narcotrend monitoring to keep the monitoring value of Narcotrend at D level.Observation and recording of 3.1 general data: sex, age, ASA grade, weight, head-down time, intraoperative infusion volume, urine volume,8 hours after operation, the serum S100 尾 protein level. 3. 2 recorded the time of Narcotrend index changing from D to A in the recovery period of the two groups.Whether there was restlessness in recovery period or not, the GCS score of the two groups in convalescence period was recorded. The statistical analysis was carried out by SPSS12.0 software.The measurement data were expressed as x 卤SD, and the t test was used for the significant test of the difference between groups, and the count data was calculated by X2 test. P05 showed that there was statistical difference.Results 1 the general condition of the two groups, such as gender, age, ASA grade, weight, operation time, head-low time, intraoperative fluid volume, urine volume, etc.There was no significant difference between the two groups in the time required for the Narcotrend index to change from D to A in the recovery period of the two groups, and the difference between the two groups was statistically significant.The postoperative GCS score of dexamethasone group was higher than that of control group. The serum S100 尾 protein concentration in dexamethasone group was higher than that in control group at 8 hours postoperatively.Conclusion 1 the application of dexamethasone in laparoscopically assisted radical resection of rectal cancer can improve the quality of anaesthesia recovery by using Narcotrend monitoring in the recovery stage of anesthesia, which can effectively and objectively reflect the patients' consciousness and shorten the recovery time of anesthesia.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614;R735.37
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本文编号：1716290