發(fā)布時間：2018-03-14 12:20

  本文選題：異丙酚　切入點：瑞芬太尼　出處：《中南大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：觀察異丙酚勻速輸注誘發(fā)肌陣攣的現(xiàn)象的特點及預先注射瑞芬太尼對其的影響。 方法：64名ASA分級Ⅰ～Ⅱ級,年齡18～40歲,在氣管插管全麻下行擇期手術的患者,隨機分為C、R兩組(n=32)。C組采用異丙酚以4000mg/h速度泵入,輸注過程中予以BIS監(jiān)測。直至BIS監(jiān)測儀上的爆發(fā)抑制比(BSR)達到40%后停止試驗。如果當異丙酚全部泵注完BSR值仍未達到40%,也停止實驗,給予芬太尼和肌松藥后插管。R組先靶控輸注瑞芬太尼,輸注過程中予以BIS監(jiān)測。靶控設置：血漿靶控,Minto藥代動力學參數(shù),靶控濃度4ng/ml。待達到目標濃度繼續(xù)輸注10min后與C組一樣將異丙酚以4000mg/h速度泵入,直至BIS監(jiān)測儀上的爆發(fā)抑制比(BSR)達到40%后停止試驗。試驗期間觀察患者是否出現(xiàn)肌陣攣現(xiàn)象及行肌陣攣嚴重程度分級,并判斷患者出現(xiàn)肌陣攣現(xiàn)象時的意識狀態(tài)。采用Marsh參數(shù)計算異丙酚勻速注射時效應室濃度變化。 結果：C組有24例患者出現(xiàn)肌陣攣,其發(fā)生率為75%,R組患者則未見肌陣攣現(xiàn)象。C組24例患者出現(xiàn)肌陣攣時均已處于意識消失狀態(tài),此時BIS值為29.8±5.3,且22例先于腦電爆發(fā)抑制現(xiàn)象出現(xiàn),2例后于其出現(xiàn)。另外當患者出現(xiàn)肌陣孿現(xiàn)象的異丙酚效應室濃度為5.28±1.75μg/ml,低于患者出現(xiàn)腦電爆發(fā)抑制時的效應室濃度p0.05)。 結論：異丙酚勻速輸注誘發(fā)肌陣攣現(xiàn)象時患者已處于一個較深的麻醉狀態(tài),且異丙酚誘發(fā)的肌陣攣現(xiàn)象與其誘發(fā)的腦電爆發(fā)抑制現(xiàn)象無關。在異丙酚輸注前予以4ng/ml靶濃度的瑞芬太尼靶控輸注可以有效地抑制肌陣攣現(xiàn)象的發(fā)生。
[Abstract]:Objective: To observe the characteristics of the phenomenon of myoclonus induced by propofol infusion and the effect of pre injection of remifentanil on it.
Methods: 64 patients of ASA grade I-II, age 18~40 years old, during tracheal intubation under general anesthesia were randomly divided into two groups of C, R (n=32).C group of propofol at the speed of 4000mg/h pump, BIS monitoring to lose in the process of injection. Until the outbreak of BIS monitor on the suppression ratio (BSR) reached 40% after the stop test. If all the infusion pump propofol BSR value has not yet reached 40%, also stop the experiment, fentanyl and muscle relaxants after intubation in group.R first target controlled infusion of remifentanil, BIS monitoring to lose in the process of injection. Setting: target controlled target controlled Minto, the pharmacokinetic parameters of target to reach the target controlled concentration 4ng/ml. concentration after 10min infusion and group C as propofol at the speed of 4000mg/h pump, until the outbreak of BIS monitor suppression ratio (BSR) reached 40% after the stop test. During the test were observed for severe myoclonus and myoclonus The degree of degree was graded and the conscious state of the patients with myoclonus was judged. The Marsh parameters were used to calculate the change of effect room concentration when propofol was injected at a constant rate.
Results: C group had 24 patients with myoclonus, the incidence rate was 75%, R group were not myoclonus in group.C 24 patients with myoclonic have lost consciousness in the state, and the BIS value is 29.8 + 5.3, and 22 cases before the EEG burst suppression phenomenon, 2 cases in the in addition. When the effect site concentration of propofol in patients with myoclonus phenomenon is 5.28 + 1.75 g/ml, lower than that of patients with EEG burst suppression effect when the chamber concentration of P0.05).
Conclusion: propofol infusion speed induced myoclonus phenomenon when patients have been in a deep anesthesia, and EEG myoclonus induced by propofol and induced burst suppression phenomenon. The 4ng/ml target concentration of remifentanil target in propofol infusion before controlled infusion can effectively inhibit the occurrence of myoclonus.

【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

【參考文獻】

相關期刊論文 前2條

1 張馬忠,王珊娟,杭燕南,吳健;靶控輸注異丙酚的臨床應用和準確性評價[J];中華麻醉學雜志;2002年11期

2 于布為,彭章龍,趙永泉;高齡病人異丙酚分步TCI時效應室濃度及BIS的變化[J];中華麻醉學雜志;2002年12期

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本文編號：1611177