腹腔镜手术患者围手术期的应激状态和麻醉质量受右旋美托咪叮的影响(论文4900字)
摘要：目的 探究腹腔镜手术患者围手术期的应激状态及术中麻醉质量受右旋美托咪叮的影响。方法 选取我院2012年10月至2014年10月收治的180例腹腔镜手术患者，采用随机数字表法将这些患者均分为研究组与对照组。研究组患者在接受麻醉5min前开始静脉滴注右旋托美咪叮0.25μg/kg•h至手术完成；对照组患者在接受麻醉5min前开始静脉滴注生理盐水溶液至手术完成。术中使BIS值保持在45左右，呼气末二氧化碳分压保持在40mmHg左右，腹腔镜的CO2气腹压力保持在12mmHg左右。记录两组患者在术前5min时、气腹20min时、手术完成时、气管插管移除时几个时间点的平均动脉压（MAP）、心率（HR）等指标，同时在以上时间点对患者体内去甲肾上腺素（NE）、血糖（GLU）、皮质醇（Cor）水平进行测定。并记录患者手术过程的麻醉时间、气腹时间、术后清醒时间以及患者术后的不良反应。结果 研究组与对照组患者的手术麻醉时间、气腹时间、术后清醒时间均无明显差异（P>0.05）。两组患者术后均有一定例数的患者发生不良反应，但研究组患者更少（P<0.05）。与术前相比，两组患者气腹20min时、手术完成时、气管插管移除时的MAP、HR、NE、GLU、Cor均不同程度的升高，尤其是在气腹20min时升高更明显。研究组与对照组相比，术前的MAP、HR、NE、GLU、Cor均无差异（P>0.05）；而气腹20min时、手术完成时、气管插管移除时，研究组的MAP、HR、NE、GLU、Cor均较对照组更低（P<0.05）。结论 对腹腔镜手术患者使用右旋托美咪叮可良好的控制患者围手术期的应激反应，并可在一定程度上减少患者的不良反应，对麻醉质量的提高有良好的促进作用。
关键词：腹腔镜手术患者；应激状态；麻醉质量；右旋托美咪叮
The effect of stress state in the perioperative period of laparoscopic operation in patients with operation and quality of anesthesia by dextral beautiful Mi bite
Abstract:Objective To explore the impact of the quality of anesthesia by dexmedetomidine and surgery perioperative period of laparoscopic operation in patients with operation.Methods From October 2014 to October 2012, 180 cases of laparoscopic surgery were selected,the patients were randomly divided into study group and control group by random digits table method.The patients in the study group received anesthesia started before 5min, intravenous drip with 0.25μg/kg•h dexmedetomidine to the operation;The control group received the intravenous drip of normal saline solution before anesthesia 5min.The BIS value was kept in 45, PETCO2 was maintained at 40mmHg or so,laparoscopic CO2 pneumoperitoneum pressure was maintained at about 12mmHg.Patients in two groups were recorded at 5 min before operation, pneumoperitoneum 20min, when the surgery is complete, tracheal intubation removed several time points of map, HR and other indicators,the levels of NE, GLUand Cor were measured at the same time.And record the time of anesthesia, pneumoperitoneum time, postoperative recovery time and postoperative adverse reactions of patients during operation.Result There were no significant difference between the study group and the control group of patients with operation time, anesthesia time, postoperative recovery time of pneumoperitoneum (P>0.05).Two groups of patients with a certain number of patients after surgery have adverse reactions, but the study group patients less (P<0.05).Compared with the preoperative, two groups of patients with pneumoperitoneum 20min, when the surgery is complete, tracheal intubation to remove the map, HR, NE, Glu, cor are different degrees of increase, especially in pneumoperitoneum for 20 min increased more significantly.Compared with the control group, there was no difference in MAP, HR, GLU, NE, Cor (P>0.05).And pneumoperitoneum for 20 min, when the surgery is complete, tracheal intubation is removed, the study group map, HR, NE, Glu, cor were lower than those in the control group were lower (P <0.05).Conclusion On the stress reaction of patients with peri operation period of control can be used with dexmedetomidine of patients undergoing laparoscopic operation,and to a certain extent, reduce the adverse reactions of patients,it has a good effect on the improvement of the quality of anesthesia.
Key words:Patient of laparoscopic operation;Stress state;Anesthesia quality; Dexmedetomidine
|
