【作者】 杨君芳；

【导师】 于金贵；

【作者基本信息】 山东大学 ， 麻醉学（专业学位）， 2013， 硕士

【摘要】 背景和目的：右美托咪定是一种新型、强效、高选择性的α2-肾上腺受体激动剂,是咪唑类衍生物,具有较强的镇静、抗焦虑、无呼吸抑制、稳定血流动力学等作用。脑内α2-肾上腺受体最密集的区域是负责调解觉醒和睡眠的脑干蓝斑。右美托咪定的镇静作用主要是因为它与脑内蓝斑核内的α2-肾上腺受体结合,能引发并维持自然非动眼睡眠。右美托咪定作用于脑内蓝斑核内的α2-肾上腺受体,产生镇静、镇痛、抑制交感活动的同时,能有效的保持患者术中唤醒状态。同时也有研究表明,右美托咪定在发挥良好镇静效果的同时,也对脑神经细胞有一定的保护作用。BIS是将脑电图(electmencepha-logram,EEG)的功率和频率经快速傅立叶转换及双频技术处理后得到的一个数字,用0—100表示,数值越大,患者越趋于清醒。BIS能反映大脑皮质的功能状况,已被认为是评估患者意识状态的敏感、准确的客观指标。OAA/S评分是临床镇静评分中非常有代表性的一种主观评价方法,它主要是通过对患者进行声音指令和触觉干扰指令来判断患者的镇静深度。本实验目的就在于比较BIS与OAA/S评分对不同剂量右美托咪定镇静深度监测的准确性。方法：择期腰硬联合麻醉行下肢手术60例患者,性别不限,年龄18-60岁,ASA分级Ⅰ-Ⅱ级,随机分为D1.0组(右美托咪定1.0ug/kg)、D0.75组(右美托咪定075ug/kg)和D0.5组(右美托咪定0.5ug/kg),每组20例。所有患者心肺肝肾功能正常,无精神神经系统疾病史,无水电解质紊乱及酸碱失衡,术前没有使用精神镇静药物。手术时间均长于2小时。BIS电极贴在左侧颞额部,BIS结果显示良好。选择L3-4椎间隙行腰硬联合麻醉,麻醉效果满意。摆好手术体位后开始静脉输注不同初始剂量盐酸右美托咪定(4ug/ml),D1.0组1Omin输注1.0ug/kg,D0.75组10min输注0.75ug/kg,D0.5组10min输注0.5ug/kg,三组均按0.5ug/kg/h维持剂量输注,到手术结束前30min停药。输注盐酸右美托咪定前记录BIS和OAA/S评分为基础值,初始量输注结束后每5min记录一次BIS(?)0AA/s评分结果：1.三组患者一般资料组间比较差异无统计学意义;2.OAA/S评分为5、4、3、2、1时,患者BIS值分别为94(97-88)、80(86-73)、71(76～58)、55(59-48)、44(49～36)：3.三组病人BIS与OAA/S评分具有较好相关性;4.OAA/S评分≤2时,患者最佳BIS值为55。结论：BIS能较为准确地监测右美托咪定的镇静深度,但其比OAA/S评分法没有优势。更多还原

【Abstract】 Objective The dexmedetomidine set a new, potent, highly selective alpha2-adrenergic receptor agonist, imidazole derivatives. Both a strong sedative, anxiolytic, respiratory depression, stable hemodynamics role.Brain alpha2-adrenergic receptor receptor most intensive area is responsible for the mediation of arousal and sleep brainstem locus coeruleus. The sedative effect of dexmedetomidine given mainly because it is combined with the alpha2-adrenergic receptor within the brain locus coeruleus, can lead to maintaining the natural non-REM sleep.Dexmedetomidine role of alpha2-adrenergic receptor in the brain locus coeruleus, produce sedation, analgesia, while inhibition of sympathetic activity, which can effectively keep the patients in the wake state. Studies have shown that dexmedetomidine set at the same time play a good sedative effect, a protective effect on brain cells.BIS (electmencepha-logram, EEG), EEG power and frequency by fast Fourier transform and dual-band technology processing a number with0-100, the greater the value, the patients tend to be more awake. BIS can reflect the functional status of the brain cortex is considered to be sensitive, accurate assessment of the patients state of consciousness objective indicators.OAA/S score is very representative clinical sedation score a subjective evaluation method, it is primarily to determine the patient’s depth of sedation in patients with voice commands and tactile interference instruction.Our Purpose of the experiment is to compare the accuracy of the application of BIS and OAA/S score in monitoring sedation depth with different doses of dexmedetomidine.Methods60patients undergoing combined spinal-epidural anesthesia for lower limb operation(ASA grade Ⅰ-Ⅱ grade) were randomly divided into group D1.0, group D0.75and group DO.5(n=20). Male or female. Operation times were longer than2hours,. Combined spinal-epidural anesthesia were performed at L3-4, and anaesthesia effects were satisfactory. Different initial doses of dexmedetomidine (4ug/ml) were infused after the patients were well positioned. Group D1.0:1.0ug/kg dexmedetomidine was infused for10min, Group DO.75:0.75ug/kg dexmedetomidine was infused for10min, Group DO.5:0.5ug/kg dexmedetomidine was infused for10min, All of the groups were followed by continuous infusion(0.5ug/kg/h) until30min before the end of the operation. BIS and OAA/S scores were recorded before the infusion of dexmedetomidine for the basic value, and every5min after the initial infusion of dexmedetomidine.Results:1There was no significant difference between the general information of the three group of patients;2when the OAA/S scores were94(97～88)、80(86～73)、71(76～58)、55(59～48)、44(49～36);3There was a good correlation between BIS and the OAA/S scores of the three groups of patients;4When the OAA/S scores≤2,the optimal BIS value of dexmedetomidine group patients was55.Conclusion BIS can accurately monitor the sedation depth of dexmedetomidine, but it shows no advantages over the OAA/S scores.更多还原