本文關(guān)鍵詞： 氟比洛芬酯 右美托咪定 瑞芬太尼 痛覺過敏　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景:瑞芬太尼因具有起效快、藥效強、可控性高、重復(fù)和持續(xù)輸注無蓄積等理想麻醉藥物的諸多優(yōu)點,臨床應(yīng)用普遍。但由于其獨特的超短效代謝特性,高劑量或者長時間應(yīng)用可使病人產(chǎn)生痛覺過敏。氟比洛芬酯和右美托咪定分別是常用的鎮(zhèn)痛、鎮(zhèn)靜藥物,二者防止痛覺過敏的機制不同,期待聯(lián)合用藥發(fā)揮協(xié)同作用并降低不良反應(yīng)的發(fā)生率。目的:觀察氟比洛芬酯和右美托咪定聯(lián)合應(yīng)用對瑞芬太尼麻醉后痛覺過敏的效果及影響。方法:選擇ASA分級Ⅰ或Ⅱ級擇期行甲狀腺癌根治術(shù)的病人120例,使用計算機生成的隨機數(shù)字表分成四組(n=30)即對照組:C組;實驗組:F組,D組,F+D組。術(shù)前和術(shù)后0.5h、1h用Von Frey Hair纖毛機械刺激針分別測量患者的痛閾值。C組病人手術(shù)開始時靜脈注射等容量的0.9%的氯化鈉溶液;F組病人麻醉誘導(dǎo)前10分鐘時靜脈給予氟比洛芬酯2mg/kg;D組病人麻醉誘導(dǎo)時靜脈給予右美托咪定1μg/kg(勻速輸注時間設(shè)定30分鐘);F+D組病人麻醉誘導(dǎo)前10分鐘時靜脈給予氟比洛芬酯1mg/kg,并在麻醉誘導(dǎo)時,開始靜脈給予右美托咪定0.5μg/kg(勻速輸注時間設(shè)定30分鐘)。靜脈輸注瑞芬太尼0.20μg·kg-1·min-1,根據(jù)Narcotrend 37-64調(diào)整丙泊酚用量。術(shù)畢停藥,送入PACU。結(jié)果:四組病人的年齡、BMI、性別比、ASA分級、麻醉時間、拔管時間、術(shù)中低血壓的發(fā)生率比較差異無統(tǒng)計學(xué)意義(P0.05);同C組比較,F、D、F+D組患者術(shù)后0.5h、1h后手術(shù)部位與非手術(shù)部位皮膚痛閾值下降的發(fā)生率明顯降低(P0.05),F組術(shù)后惡心嘔吐的發(fā)生率升高(P0.05),D組術(shù)中心動過緩(HR45次/min)的發(fā)生率明顯升高(P0.05)。F、D、F+D三組患者術(shù)后0.5h、1h后手術(shù)部位與非手術(shù)部位皮膚痛閾值下降的發(fā)生率之間比較差異無統(tǒng)計學(xué)意義(P0.05)。與F組比較,F+D組術(shù)后惡心嘔吐的發(fā)生率降低(P0.05);與D組比較,F+D組術(shù)中心動過緩(HR45次/min)的發(fā)生率明顯降低(P0.05)。結(jié)論:麻醉誘導(dǎo)前10分鐘時靜脈給予氟比洛芬酯1mg/kg,并在麻醉誘導(dǎo)時,靜脈給予右美托咪定0.5μg/kg(勻速輸注時間設(shè)定30分鐘),可有效防止瑞芬太尼麻醉后產(chǎn)生的痛覺過敏,不影響拔管時間,且降低麻醉藥物不良反應(yīng),臨床上值得推薦。
[Abstract]:Background: remifentanil has rapid onset, high efficacy, high controllability, repeated and continuous infusion of non ideal anesthetic advantages accumulation, clinical application of common. But because of its unique ultra short acting metabolic properties, high dose or long time application can make the patient produces hyperalgesia. Flurbiprofen and right dexmedetomidine is commonly used analgesic, sedative drugs, two mechanism to prevent hyperalgesia, look forward to the combination synergistic effect and reduce the incidence of adverse reaction. Objective: To observe the effect of flurbiprofen axetil and dexmedetomidine combined application of hyperalgesia after remifentanil anesthesia and its effect. Methods: ASA grade I or II undergoing resection of thyroid cancer patients 120 cases, randomly divided into four groups using a computer-generated (n=30): control group: C group; experimental group: F group, D group, F+D group. The preoperative and postoperative 0 .5h, 1H Von Frey Hair cilia mechanical stimulation pain threshold needle were measured in group.C patients, surgical patients with Sodium Chloride Solution 0.9% intravenous injection capacity at the beginning; 10 minutes before induction of intravenous flurbiprofen axetil 2mg/kg group F patients during induction of anesthesia; intravenous dexmedetomidine anesthesia 1 g/kg patients (D group constant infusion time set 30 minutes); 10 minutes before induction of intravenous flurbiprofen axetil 1mg/kg group F+D anesthesia, and during anesthesia induction, start intravenous dexmedetomidine 0.5 g/kg (constant infusion time set 30 minutes). Intravenous infusion of remifentanil 0.20 G - kg-1 - min-1, according to Narcotrend 37-64 to adjust the dosage of propofol. Postoperative withdrawal into the PACU. results: four groups of patient's age, sex ratio, BMI, ASA grade, anesthesia time, extubation time, there was no significant difference in the incidence of intraoperative hypotension (P0.05); group C ratio 杈，

本文編號：1461912