本文選題：右美托咪定 + 顱內(nèi)動(dòng)脈瘤栓塞術(shù)　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究擬通過(guò)觀察右美托咪定預(yù)防顱內(nèi)動(dòng)脈瘤栓塞術(shù)患者全麻插管交感神經(jīng)反應(yīng)的效果及對(duì)血清腫瘤壞死因子-a(tumor necrosis factor-a,TNF-a)和白細(xì)胞介素-6(interleukin,IL-6)水平的影響,探討右美托咪定對(duì)顱內(nèi)動(dòng)脈瘤栓塞術(shù)患者腦保護(hù)的作用機(jī)制。方法:選取在本院進(jìn)行全身麻醉行顱內(nèi)動(dòng)脈瘤栓塞手術(shù)的患者80例作為研究對(duì)象,男女不限,年齡18~66歲,ASA分級(jí)為Ⅰ或Ⅱ級(jí)。入選患者體質(zhì)量指數(shù)在16kg/m2~28kg/m2,術(shù)前無(wú)嚴(yán)重肺、心、肝等疾病患者。使用隨機(jī)數(shù)字表法,將患者隨機(jī)分為2組(n=40):對(duì)照組(C組)和右美托咪定組(D組)。麻醉誘導(dǎo)前10min,右美托咪定組經(jīng)靜脈輸注右美托咪定1μg/kg(10min內(nèi)輸注完畢),隨后以0.4μg·kg~（-1）·h~（-1）的速率持續(xù)輸注至手術(shù)結(jié)束前30min,對(duì)照組采用同樣的方法靜脈輸注等容量的生理鹽水。麻醉誘導(dǎo):靜脈注射咪達(dá)唑侖0.05mg/kg、舒芬太尼0.5μg/kg、依托咪酯0.3 mg/kg和羅庫(kù)溴銨0.6 mg/kg誘導(dǎo),經(jīng)口明視下行氣管插管,固定氣管導(dǎo)管,連接麻醉機(jī)行機(jī)械通氣,行橈動(dòng)脈穿刺置管測(cè)壓。機(jī)械通氣潮氣量6~10ml/kg,通氣頻率11~14次/分,維持呼末二氧化碳(PETCO2)在35~40mm Hg之間,血氧飽和度95%,氣道壓40mm Hg。麻醉維持:微量泵靜脈輸注瑞芬太尼0.05~0.2μg·kg~（-1）·min~（-1）,丙泊酚4~8mg·kg~（-1）·h~（-1）,術(shù)中根據(jù)手術(shù)刺激強(qiáng)弱調(diào)整劑量。術(shù)中維持平均動(dòng)脈壓波動(dòng)幅度不超過(guò)基礎(chǔ)值的20%,BIS值在40~60之間。術(shù)畢患者清醒后拔除氣管導(dǎo)管送返病房。記錄患者入手術(shù)室平靜休息3 min(T1)、氣管內(nèi)插管前即刻(T2)、插管后即刻(T3)、插管后3 min(T4)的舒張壓(DBP)、收縮壓(SBP)、心率(HR),將患者麻醉誘導(dǎo)期間的舒張壓、收縮壓和心率最大值和最小值的差定義為波動(dòng)值。于患者入手術(shù)室平靜休息3 min(T1)、動(dòng)脈瘤栓塞前即刻(T5)、手術(shù)結(jié)束時(shí)(T6)、術(shù)后6h(T7)、術(shù)后24h(T8)取橈動(dòng)脈血,靜置30min,以3000r/min離心10min,取上清液,酶聯(lián)免疫吸附(ELISA)法測(cè)定血清TNF-a和IL-6的水平。結(jié)果:插管時(shí)血流動(dòng)力學(xué)變化與T1時(shí)比較,對(duì)照組T2時(shí)收縮壓明顯降低(P0.05),T3、T4時(shí)收縮壓和心率及T3時(shí)舒張壓明顯升高(P0.05),右美托咪定組T2時(shí)的收縮壓和心率及T4時(shí)收縮壓和舒張壓明顯降低(P0.05)。與對(duì)照組比較,右美托咪定組患者T3、T4時(shí)的收縮壓、舒張壓及心率均降低(P0.05),收縮壓、舒張壓和心率的波動(dòng)值均顯著降低(P0.05)。血清TNF-a和IL-6的水平與T1時(shí)比較,兩組T6-8時(shí)的血清TNF-a和IL-6水平均升高(P0.05),與對(duì)照組比較,右美托咪定組T6-8時(shí)的血清TNF-a和IL-6水平均降低(P0.05)。結(jié)論:給予1μg/kg的右美托咪定負(fù)荷量,隨后以0.4μg·kg~（-1）·h~（-1）的速率持續(xù)輸注,可以預(yù)防顱內(nèi)動(dòng)脈瘤患者全麻插管時(shí)的交感神經(jīng)反應(yīng),同時(shí)可以降低顱內(nèi)動(dòng)脈瘤栓塞術(shù)患者術(shù)后血清炎性因子的水平。
[Abstract]:Objective: to observe the effect of dexmetomidine on the sympathetic response in patients with intracranial aneurysm embolization under general anesthesia and the effect of dexmetomidine on the levels of serum tumor necrosis factor (TNF- 偽) and interleukin-6 interleukin-6 (IL-6) in patients with intracranial aneurysm embolization. To investigate the protective mechanism of dexmetomidine on brain in patients undergoing intracranial aneurysm embolization. Methods: 80 patients with intracranial aneurysm embolization under general anesthesia in our hospital were selected as the study subjects, male and female were not limited, the age was 18 ~ 66 years old with ASA grade 鈪，

本文編號(hào)：1774892