【作者】 宋智敏；

【导师】 叶琳；

【作者基本信息】 吉林大学 ， 公共卫生， 2011， 硕士

【摘要】 右美托咪定是一种新型、高选择性α₂肾上腺素能受体激动剂,具有镇静镇痛、抗焦虑、稳定血流动力学、无呼吸抑制、术后遗忘等作用。因此在很多临床领域都得到广泛应用,尤其在麻醉辅助用药方面,为麻醉医生提供了一种新的选择。然而有关右美托咪定在眼科手术中应用的研究甚少。目的:评价右美托咪定在眼科手术局麻强化中镇静、镇痛、维持血流动力学稳定、诱导遗忘等效果。方法:选择择期行眼科手术的局麻强化患者100例为研究对象,其中行玻璃体切除术患者50例,小梁切除术患者50例。美国麻醉医师协会分级Ⅰ～Ⅱ级,年龄16～80岁,体重35～80 kg。将研究对象分为两组,实验组（右美托咪定组）和对照组（安慰剂组）,每组各50例,两种患者各25例。实验组患者手术开始前10min给予右美托咪定负荷剂量0.5μg/kg,输注时间大于10 min,之后以0.5μg/（kg*h）进行维持;对照组给予等体积的生理盐水。手术医生用2%利多卡因进行球周浸润麻醉时,两组患者均给予静脉注射半量芬氟合剂（芬太尼50μg +氟哌利多2.5mg）。记录手术开始前10mim（T₀）、开始时（T₁）、开始后10min（T₂）、开始后30min（T₃）、开始后60min（T₄）、手术结束时（T₅）两组患者的呼吸频率、心率、收缩压、舒张压、平均动脉压、VAS评分和Ramsay评分,同时记录术中合作程度、术后遗忘程度和术后不良反应。采用SPSS 13.0统计软件进行统计分析。结果:1.实验组和对照组患者的年龄、性别、体重、手术时间差异无统计学意义,两组研究对象具有可比性。2. Ramsay评分在T₀时两组间的差异无统计学意义,而在T₁～T₅时差异显著,且实验组的镇静评分显著高于对照组。3. VAS评分在T₀时两组间的差异无统计学意义,而在T₁～T₅时差异显著,且实验组镇痛评分显著低于对照组。4. T₀时刻实验组和对照组患者的SBP无统计学差异,而HR、DBP、MAP差异显著,且实验组显著低于对照组;T₁时刻实验组和对照组的HR、DBP、MAP无统计学差异,而SBP差异显著,且实验组显著低于对照组;T₂～T₅时刻HR、SBP、DBP、MAP在两组间差异显著,且实验组均低于对照组。5. RR在T₀时刻两组间的差异无统计学意义,而在T₁～T₅时刻差异显著,且实验组患者的RR显著低于对照组。6.患者术中合作程度在实验组和对照组间差异无统计学意义。术后遗忘程度在两组之间的差异显著,具有统计学意义,且实验组中完全遗忘者所占的比例（68%）显著高于对照组（0%）。7.恶心、呕吐、呼吸抑制、心动过缓、躁动和嗜睡的发生率在实验组和对照组间的差异不具有统计学意义。结论:1.在眼科局麻手术中应用右美托咪定,可为患者提供满意舒适的镇静,且不降低术中患者的合作程度。2.右美托咪定具有镇痛作用,能够增加眼科局麻手术患者对疼痛的耐受性。3.右美托咪定能够维持血流动力学的稳定。4.右美托咪定能够消除眼科局麻手术患者对麻醉和手术操作等的不良记忆,具有一定的顺行性遗忘作用。5.眼科局麻手术中右美托咪定的应用不会增加恶心、呕吐、呼吸抑制、心动过缓、躁动和嗜睡等不良反应的发生率。更多还原

【Abstract】 Dexmedetomidine is a new type of high selectiveα₂-adrenergic receptor agonists, which has sedative, analgesic and anxiolytic effects, can maintain hemodynamic stability, has no respiratory depression, amnesia after surgery and son on. Therefore it has applications in many fields of clinical medicine, especially as an adjuvant in anesthesia, providing the anesthesiologist a new choice. However, there is little research about giving the dexmedetomidine in ophthalmic surgery.Objective: Evaluate the effects of sedative, analgesic, maintaining hemodynamic stability and forgotten, when dexmedetomidine was applicated to patients in ophthalmic surgery under local anesthesia.Methods: Select 100 patients who were undergoing ophthalmic surgery with local anesthesia as the research object, 50 patients with vitrectomy, 50 patients with trabeculectomy. All the patients were ASAⅠ-Ⅱ, aged 16-80 years, weight 35-80 kg, of Which 50 patients with vitrectomy and the other 50 ones with trabeculectomy. Patients were divided into two groups, the experimental group（dexmedetomidine group） and control group （placebo group）. Each group has 50 patients. The patients of the experimental group before surgery 10 min were given dexmedetomidine loading dose of 0.5μg/kg, the infusion time is greater than 10 min, followed by 0.5μg /（kg·h） for maintenance; control group received an equal volume of physiological salt. When the surgeon with 2% lidocaine for peribulbar anesthesia, the two groups of patients were given intravenous injection of half the amount of fentany-droperidol mixture （fentanyl 50μg+droperidol 2.5mg）. Routine monitoring and recording the respiratory rate （RR）, heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, main arterial blood pressure（MAP）, VAS score and Ramsay score of patients in each group at 10 min before surgery （T₀）, the time of starting surgery（T₁）, 10 min after the start of surgery（T₂）, 30 min after the start of surgery（T₃）, 60 min after the start of surgery（T₄） and at the end of surgery （T₅）, at the same time, recording the level of cooperation between intraoperative, the degree of surgical forgotten and postoperative adverse. Use SPSS 13.0 statistical software for statistical processing.Results:1. The difference between experimental group and control group in age, gender, weight and operation tine was not statistically significant. The two group had comparability.2. Ramsay score was not significantly different between two groups at T₀, while was at T₁～T₅. Furthermore, Ramsay score in experimental group was significantly higher than control group.3. VAS score was not significantly different between two groups at T₀, while was at T₁～T₅. Furthermore, VAS score in experimental group was significantly lower than control group.4. At the time of T₀, SBP was not significantly different between experimental group and control group, while HR, DBP and MAP were. Furthermore, HR, DBP and MAP in experimental group were significantly lower than control group. At the time of T₁, HR, DBP and MAP were not significantly different between two groups, while SBP was. Furthermore, SBP in experimental group was significantly lower than control group. At the time of T₁～T₅, HR, SBP, DBP and MAP were significantly different between two groups, and all of them in experimental group were significantly lower than control group.5. RR was not significantly different between two groups at T₀, while was at T₁～T₅. Furthermore, RR in experimental group was significantly higher than control group.6. Cooperation degree of patients was not significantly different between experimental group and control group during surgery. The degree of postoperative forgotten was significantly different between two groups, and the rate of completely forgotten in experimental group （68%） was statistically higher than control group （0%）.7. The number of cases of nausea, vomiting, respiratory depression, bradycardia, restlessness and drowsiness were not significantly different between experimental group and control group.Conclusion:1. The application of dexmedetomidine in ophthalmic surgery under local anesthesia could make the Ramsay score of experimental group significantly higher, with providing comfortable calm for patients and not decreasing the cooperation degree during surgery.2. Dexmedetomidine had analgesic effect, which can increase tolerability to pain for patients with ophthalmic surgery under local anesthesia.3. Dexmedetomidine could maintain hemodynamic stability.4. Dexmedetomidine could eliminate poor memory appearing because of anesthesia and operation of surgery in ophthalmic surgery under local anesthesia. Therefore, dexmedetomodine had a certain line of the forgotten role.5. The application of dexmedetomidine in ophthalmic surgery under local anesthesia will not produce nausea, vomiting, respiratory inhibition, bradycardia, restlessness and drowsiness.更多还原