本文選題：長托寧 + 腰硬聯(lián)合麻醉�。� 參考：《吉林大學》2014年碩士論文

【摘要】：目的：探討長托寧預先給藥防治腰硬聯(lián)合麻醉后寒戰(zhàn)的有效率，，以及患者血流動力學變化及鎮(zhèn)靜效果。 方法：將80例擇期行全子宮切除手術患者的ASAI~II級、年齡45~60歲,體重50~70kg，身高155~165cm,BMI18~25kg/m2的病人隨機分為兩組：A組（長托寧組)、B組（空白對照組）。于麻醉開始前5min，A組靜脈注射長托寧0.01mg/kg(用生理鹽水稀釋到2ml)，B組靜脈注射相同體積的生理鹽水�；颊卟扇∮覀扰P位，于L2-3間隙穿刺進入蛛網膜下間隙后，勻速推注0.75%的布比卡因2.0ml（10-20sec內），置入導管于硬膜外間隙。固定導管后患者改為平臥位，用體位法調整阻滯平面在T6以下。術中根據腰麻作用減退情況酌情經硬膜外導管追加利多卡因3～5ml。術中連續(xù)監(jiān)測ECG、NIBP，并記錄入室（T1）、切皮（T2）、牽拉腹膜(T3)、探查盆腹腔(T4)、牽拉子宮(T5)、關腹(T6)、手術結束(T7)時的心率（HR）及平均動脈壓（MAP）。患者入室時的HR及MAP采用患者在手術床上靜臥10分鐘后的HR及MAP。觀察寒戰(zhàn)發(fā)生率。觀察并記錄試驗對象的鎮(zhèn)靜評分（Ramsay評分）。結果：（1）兩組病人的一般情況，兩組患者的ASA分級、年齡、體重，輸液量，出血量，尿量，沖洗量和手術時間的差異無統(tǒng)計學意義（P0.05）。（2）兩組患者麻醉后，MAP均有所下降，與入室時相比有統(tǒng)計學意義（P0.05），手術快結束時恢復至基礎水平。兩組患者均于牽拉子宮時MAP最低，B組MAP降低較A組有統(tǒng)計學意義（P0.05），其余各時間點各組間無統(tǒng)計學差異（P0.05）。組內比較，A組靜注長托寧后，各時間點HR與基礎值相比無顯著差異（P0.05），而B組在牽拉腹膜、腹腔探查及牽拉子宮時，心率有所下降，（T3、T4、T5）與T1相比，有統(tǒng)計學意義（P0.05）。組間比較，兩組患者在牽拉子宮時HR差別有統(tǒng)計學意義（P0.05），其余各時間點均無顯著差異（P0.05）。（3）A組的鎮(zhèn)靜評分明顯高于B組（P0.05）。兩組寒戰(zhàn)發(fā)生率經檢驗，差異具有統(tǒng)計學意義（P0.05）。兩組患者惡心嘔吐發(fā)生率無明顯差異（P0.05）。 結論：長托寧預先給藥在腰硬聯(lián)合麻醉中應用有利于患者血流動力學穩(wěn)定，減少寒戰(zhàn)發(fā)生率，同時提高患者的鎮(zhèn)靜滿意度，無藥物不良反應的發(fā)生。
[Abstract]:Objective: to investigate the efficacy of Changtonin in preventing and treating shivering after combined spinal-epidural anesthesia, hemodynamic changes and sedative effect. Methods: 80 patients with ASAI II, aged from 45 to 60 years old, weighing 50 ~ 70 kg and standing 155 ~ 165 cm / m ~ (-1) BMI18 ~ (18) kg / m ~ 2, were randomly divided into two groups: group A (Changtonin group) and group B (blank control group). Five minutes before anesthesia, group A was injected with Changtonin 0.01mg/kg (diluted to 2ml with normal saline) and group B was injected with the same volume of saline. In the right lateral position, the patients were punctured into the subarachnoid space in the L2-3 space, and 0.75% bupivacaine 2.0ml (10-20sec) was injected uniformly. The catheter was placed in the epidural space. After fixing catheter, the patient changed to supine position and adjusted the block level below T 6 by posture. According to the hypofunction of spinal anaesthesia, Lidocaine was added through epidural catheter at 5 ml. During the operation, continuous monitoring of ECGV NIBP was performed, and the heart rate (HR) and mean arterial pressure (map) at the end of operation (T7) were recorded, and the heart rate (HR) and mean arterial pressure (map) were recorded at the end of operation (T7), peritoneal traction (T3), pelvic exploration (T4), traction uterus (T5), closure of abdomen (T6), heart rate (HR) and mean arterial pressure (map) at the end of operation (T7). HR and map of the patients at the time of entering the room were treated with HR and MAPP after 10 minutes of lying still on the operating bed. Observe the incidence of shivering. The sedation score (Ramsay score) was observed and recorded. Results: (1) there was no significant difference in ASA grade, age, body weight, transfusion volume, blood loss, urine volume, irrigation volume and operation time between the two groups (P0.05). (2). Compared with the time of entry, there was statistical significance (P0.05), the operation was almost over to the basic level. The decrease of map in group B was significantly lower than that in group A (P0.05), but there was no significant difference between the other groups at each time point (P0.05). There was no significant difference in HR between group A and T 1 after intravenously injection of Changtonin (P0.05), but in group B, the heart rate decreased when pulling peritoneum, exploring abdominal cavity and pulling uterus, (T3, T4, T5) compared with T1 (P0.05). There was significant difference in HR between the two groups when pulling uterus (P0.05). There was no significant difference in other time points (P0.05). (3). The sedation score of group A was significantly higher than that of group B (P0.05). The incidence of shivering in the two groups was statistically significant (P0.05). There was no significant difference in the incidence of nausea and vomiting between the two groups (P0.05). Conclusion: the application of Changtonin in combined spinal-epidural anesthesia is beneficial to hemodynamics stability, reduce the incidence of shivering, improve the patients' sedation satisfaction, and no adverse drug reactions.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614

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