兰州大学机构库 >学院待认领
地佐辛复合盐酸右美托咪定在小儿手术中的应用研究
Alternative TitleStudy of dezocine combined with dexmedetomidine in perioperative pediatric surgery
董静宇
Thesis Advisor石翊飒
2014-05-26
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword地佐辛 盐酸右美托咪定 围手术期 小儿
Abstract目的:观察地佐辛单独或复合盐酸右美托咪定(DEX)在小儿手术中的临床应用效果。 方法:本研究选择ASA分级Ⅰ~Ⅱ级、年龄(4~10)岁、体重(14~40)kg,择期在全麻下行扁桃体、腺样体摘除术的患儿60例,随机分为对照组(C组) 、地佐辛组(D组)、多模式镇痛组(M组),每组20例。麻醉诱导前M组以1μg/kg负荷量泵注DEX 10min,随后以0.5μg·kg-1·h-1持续泵注50min;C组、D组泵注等体积生理盐水。术毕前15min,D组、M组静脉给予地佐辛0.1mg/kg,C组注射等体积生理盐水。记录术前、泵注后5min、插管即刻、拔管即刻、拔管后5min((T1~T5)及术后1h、2h、4h、6h、24h(T6~T10)生命体征,术后躁动评分, T6~T10术后疼痛、镇静及不良反应情况,并测定T1、T6、T10患儿血清P物质、β-内啡肽、孤啡肽浓度。 结果:术后躁动发生率、躁动评分D组、M组低于C组。七氟醚用量M组低于C组。与C组T2~T9、D组T2~T8比较,M组HR均较低;与C组及D组T2比较、与M组T1比较,M组T2时SBP较高。与C组比较,D组、M组T6~T8的VAS评分、T6~T9的FLACC评分均较低;与C组比较,D组、M组T6时Ramsay评分较高。与C组比较,M组术后心动过速发生率较低。D组和M组T6、T10时血清SP、β-EP浓度均低于C组,且M组T6时低于D组;D组、M组T6、T10时血清OFQ浓度均低于C组,且M组T10时低于D组。 结论:本研究表明术毕前15min静注地佐辛0.1mg/kg可安全应用于小儿T&A,能降低术后躁动发生率,提供较为满意的术后镇痛,其机制可能与降低SP、β-EP、OFQ血清浓度水平有关;该剂量复合DEX以多模式镇痛的形式应用则更具优势,可减少术中七氟醚用量,使患儿在围术期生命体征更为平稳。
Other AbstractObjective: To investigate the effect of dezocine alone or combined with dexmedetomidine in perioperative surgery. Methods: This is a prospective, randomized, double-blind, and placebo controlled study.Sixty ASA I~II pediatric patients, aged (4~10)yrs, weighing (14~40)kg, scheduled for tonsillectomy and adenoidectomy were randomly divided into three groups (n=20 each): the control group (group C), multimodal analgesia group (group M) and the dezocine group (group D). Before induction, patients in group M started with intravenous infusion of dexmedetomidine (1μg/kg) for 10 minutes. After 10 min, dexmedetomidine (0.5μg·kg-1·h-1) were continually given to patients for 50min (in total 1h). Patients in group C and group D received the same volume of normal saline. Group D and group M received dezocine(0.1mg/kg) 15min before the end of surgery, group C received the same volume of normal saline. Vital signs were compared among the three groups at 10 time points: patient entering the operation room (T1), 5 minutes after intravenous infusion (T2), intubation (T3), extubation (T4), 5 minutes after extubation (T5), 1 hours(T6)、2 hours(T7)、4 hours(T8)、6 hours(T9)、24 hours(T10) after surgery. The duration of anesthesia and surgery, duration for anesthesia recovery and extubation, evaluation of postoperative agitation (EA),postoperative pain, sedation score and adverse reactions at time points T6~T10were compared. Serum concentrations of substance P(SP), β-endorphin(β-EP), Orphanin FQ(OFQ) of children at T1、T6、T10 were measured as well. Results: The general information and the duration of anesthesia, operation, anesthesia recovery period and extubation were not statistically different among the three groups(P>0.05). Compared with group C(65%,3.2±1.0), the incidence and the grading of EA were lower in group group D(30%,2.4±0.8)and M(10%,2.0±0.7)in anesthesia recovery period(P<0.05)Compared with group C(8.8±2.5,ml), the dosage of sevoflurane was significantly less in the group M (5.8±2.0,ml) during the surgery(P<0.05). Compared with group C during T2~T9 and group D during T2~T8, the heart rate was significantly lower in group M(P<0.05). Compared with group C and group D、T1 of group M, the SBP was significantly higher at T2 of group M (P<0.05).Compared with group C, the VAS score during T6~T8, the FLACC score during T6~T9 were significantly lower in group D and group M(P<0.05).Compared with group C, the Ramsay score of group D and ...
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Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/223634
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
董静宇. 地佐辛复合盐酸右美托咪定在小儿手术中的应用研究[D]. 兰州. 兰州大学,2014.
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