本文選題：機(jī)械通氣 + 鎮(zhèn)靜��； 參考：《浙江大學(xué)》2008年碩士論文

【摘要】： 研究背景與目的:我們通常采用鎮(zhèn)靜藥物,如咪唑安定、異丙酚等來實現(xiàn)機(jī)械通氣患者鎮(zhèn)靜的目標(biāo)。針刺療法的鎮(zhèn)靜作用在失眠癥,焦慮癥等患者的療效已有大量的文獻(xiàn)報道,但目前針刺療法應(yīng)用于重癥監(jiān)護(hù)病房(ICU)機(jī)械通氣患者鎮(zhèn)靜作用方面的報道很少。本研究的目的在于:(1)探討針刺對心臟瓣膜置換術(shù)后機(jī)械通氣患者是否有鎮(zhèn)靜作用。(2)評價腦電雙頻指數(shù)(Bispectral Index,BIS)與Ramsay評分的相關(guān)性。(3)觀察針刺是否能減少心臟瓣膜置換術(shù)后異丙酚鎮(zhèn)靜的不良反應(yīng)。(4)明確針刺對心臟瓣膜置換術(shù)后異丙酚鎮(zhèn)靜患者肺內(nèi)分流率、氧代謝是否有影響。 方法:選擇60例心臟瓣膜置換術(shù)后機(jī)械通氣患者,隨機(jī)分為3組。Ⅰ組采用單純靜脈注射異丙酚鎮(zhèn)靜,Ⅱ組針刺神庭、印堂穴并留針加靜脈注射異丙酚鎮(zhèn)靜,Ⅲ組針刺神庭、印堂穴并留針加電刺激加靜脈注射異丙酚鎮(zhèn)靜。通過調(diào)整異丙酚微泵泵速,控制BIS值70～80分。觀察3組患者異丙酚用量、Ramsay評分、不良反應(yīng)、血糖等的差異。患者全麻清醒后(即用異丙酚前)和用異丙酚后2.5h分別采集動脈血和混合靜脈血進(jìn)行血氣測定,采用公式計算肺內(nèi)分流率(pulmonary shunt fraction,Qs/Qt)及氧攝取率(oxygen extractionrate,ERO_2)。觀察鎮(zhèn)靜前及鎮(zhèn)靜后3組問呼吸頻率(RR)、Qs/Qt、ERO_2等的差異,并觀察鎮(zhèn)靜前后RR、Qs/Qt、ERO_2等變化。 結(jié)果:3組患者鎮(zhèn)靜開始后12h內(nèi)每小時異丙酚用量:Ⅰ組(1.36±0.42)mg/kg,Ⅱ組(1.51±0.42)mg/kg,Ⅲ組(0.99±0.22)mg/kg。Ⅰ組與Ⅱ組間異丙酚用量差異無統(tǒng)計學(xué)意義(P＞0.05),Ⅲ組異丙酚用量較Ⅰ組與Ⅱ組均顯著下降(P＜0.05)。3組間BIS值、Ramsay評分、不良反應(yīng)、血糖等差異均無統(tǒng)計學(xué)意義。BIS值與Ramsay評分呈負(fù)相關(guān)性(γ=-0.85,P＜0.01)�；颊哂卯惐忧凹坝卯惐雍�2.5h BIS值、RR、Qs/Qt、ERO_2、S(?)O_2 3組間差異均無統(tǒng)計學(xué)意義(P＞0.05)。患者用異丙酚后2.5h較用異丙酚前BIS值、RR、ERO_2顯著下降(P＜.05),S(?)O_2顯著上升(P＜0.05),Qs/Qt差異無統(tǒng)計學(xué)意義(P＞0.05)。 結(jié)論:(1)電針神庭、印堂穴對心臟瓣膜置換術(shù)后機(jī)械通氣患者有一定的鎮(zhèn)靜作用。(2)BIS值與Ramsay評分具有良好的相關(guān)性,是一種可靠的客觀鎮(zhèn)靜評價工具,能有效評價ICU機(jī)械通氣患者的鎮(zhèn)靜水平。(3)尚不能證明針刺神庭、印堂穴可減少心臟瓣膜置換術(shù)后異丙酚鎮(zhèn)靜的不良反應(yīng)。(4)尚不能說明針刺神庭、印堂穴對心臟瓣膜置換術(shù)后異丙酚鎮(zhèn)靜患者血糖會產(chǎn)生影響。(5)異丙酚鎮(zhèn)靜后患者RR、ERO_2顯著下降,S(?)O_2顯著上升,Qs/Qt無明顯變化。(6)針刺神庭、印堂穴對心臟瓣膜置換術(shù)后異丙酚鎮(zhèn)靜患者肺內(nèi)分流率、氧代謝未產(chǎn)生影響。
[Abstract]:Background & AIM: sedatives such as midazolam and propofol are commonly used to achieve sedation in patients undergoing mechanical ventilation. The sedative effect of acupuncture therapy in insomnia anxiety disorder and other patients has been reported in a large number of literatures but at present there are few reports on sedative effect of acupuncture therapy in patients with mechanical ventilation in intensive care unit (ICU). The purpose of this study was to investigate the sedative effect of acupuncture on mechanical ventilation patients after cardiac valve replacement.) to evaluate the correlation between bispectral index (BIS) and Ramsay score. Postoperative adverse reaction of propofol sedation. 4) the effect of acupuncture on pulmonary shunt rate in patients with propofol sedation after cardiac valve replacement. Whether oxygen metabolism has an effect. Methods: sixty patients with mechanical ventilation after cardiac valve replacement were randomly divided into 3 groups: group 鈪，

本文編號：1924391