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研究生:黃佳弘
研究生(外文):Chia-Hung Huang
論文名稱:Tiletamine-zolazepam與系統性阿托品對於貓隻眼壓及瞳孔大小的影響
論文名稱(外文):Effect of tiletamine-zolazepam and systemic atropine on the intraocular pressure and pupil diameter of the cats
指導教授:林荀龍
指導教授(外文):Shiun-Long Lin
口試委員:林中天陳建榮
口試委員(外文):Chung-Tien LinJeng-Rung Chen
口試日期:2016-07-18
學位類別:碩士
校院名稱:國立中興大學
系所名稱:獸醫學系暨研究所
學門:獸醫學門
學類:獸醫學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:66
中文關鍵詞:舒泰系統性阿托品眼壓瞳孔大小
外文關鍵詞:Tiletamine-zolazepamsystemic atropinecatintraocular pressurepupil diameter
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理想的麻醉過程應盡量減少眼壓突然的改變,尤其是在進行眼內手術,或動物本身有青光眼或眼球破裂風險時。Zoletil®為tiletamine和zolazepam兩種藥物以一比一的重量比例混合而成的藥物,並與ketamine-diazepam有相似的作用機制。雖然在犬貓單獨使用ketamine時會使眼壓顯著的上升,但在許多犬隻研究報告中,併用解離型麻醉劑與benzodiazepine類藥物時對眼壓的影響則不一定。另外,全身麻醉下常用以減少麻醉劑的副作用的膽鹼性拮抗劑atropine,在犬隻研究中認為會造成散瞳及眼壓上升的情形。然而,目前為止在貓隻並沒有手術劑量下的TZ以及系統性給予atropine對瞳孔大小及眼壓影響的相關資料,因此本研究目的在於評估手術劑量下的TZ對於貓隻眼壓及瞳孔大小的影響,以及比較有無給予atropine的情況下對於正常貓隻眼壓及瞳孔的影響為何。本實驗共蒐集45隻欲進行絕育且臨床上健康的貓隻(22隻公貓,23隻母貓;平均年齡為1.55 ± 1.03歲;平均體重為3 ± 0.89公斤)。先進行麻醉前基礎值收集,包含眼壓、瞳孔橫幅,以及其他生理數值,之後隨機分入以下三組,分別為TZA0 (12 mg/kg TZ, IM)、TZA2 (12 mg/kg TZ及0.02 mg/kg atropine, IM),與TZA4 (12mg/kg TZ及0.04 mg/kg atropine, IM)。並於藥物注射後第5、10、15、20、30、40分鐘時,測量眼壓、瞳孔橫幅,以及其他生理數值。實驗結果顯示,在組別TZA0,眼壓與瞳孔大小分別在注射後第10到15分鐘和10到30分鐘時較麻醉前低,並具有統計學上顯著意義(p< 0.05)。組別TZA2及 TZA4麻醉後的眼壓和瞳孔大小和麻醉前數值相比並無顯著差異,但皆顯著較同時間的組別TZA0高。根據本實驗結果,與先前犬隻結果不同,TZ在貓隻會造成眼壓顯著下降且有縮瞳的效果,而肌肉注射0.02 mg/kg和0.04 mg/kg的atropine 在貓有散瞳的效果,於本實驗中與TZ效果相抵銷。因此在麻醉過程中,不想讓眼壓上升時,單獨使用TZ或併用TZ及0.02-0.04 mg/kg的atropine是可以考慮的選擇。

An appropriate anesthetic protocol should minimize changes in intraocular pressure (IOP) over the entire anesthetic period, especially during the intraocular surgery or patients with near-perforating corneal lesions or glaucoma. Zoletil® (tiletamine-zolazepam, TZ) is a proprietary combination of tiletamine with zolazepam in a 1:1 ratio which is similar to ketamine-diazepam. Although ketamine would cause a significant IOP increase in dogs and cats, conflicting findings were reported in the literature concerning the effects of the dissociative agent-benzodiazepine combinations on IOP in dogs. On the other hand, systemic atropine, which is frequently used as an adjunct to general anesthesia, would cause mydriasis and a significant increase in dogs. However, there appear to be no clear data in the literature that is focused on the effect of TZ and systemic atropine on IOP and pupil diameter in cats. Hence, the purpose of this study was to evaluate the effect of TZ, with and without atropine sulfate, on IOP and pupil diameter in clinically normal cats. Forty-five clinically healthy cats (22 males and 23 females, mean age 1.55 ± 1.03-year old, mean body weight 3 ± 0.89 kg) scheduled to sterilized were included in this study. Following pre-anesthetic baseline readings of IOP, horizontal pupil diameter (HPD), and vital signs, cats were randomly allocated to 1 of 3 treatment groups: TZA0 (12 mg/kg TZ), TZA2 (12 mg/kg TZ with 0.02 mg/kg atropine), and TZA4 (12mg/kg TZ with 0.04 mg/kg atropine). IOP, HPD values, and vital signs were measured at time 5, 10, 15, 20, 30, 40min post-injection in all treatments. In TZA0 group, IOP and HPD values decreased from baseline and reached statistic differences (p<0.05) in the period between 10 and 15 min, 10 and 30 min post-treatment, respectively. In TZA2 and TZA4, group there were no statistical differences in HPD and IOP between baseline and post-treatment values during 30 min observations. However, cats in the TZA2 and TZA4 group had significantly higher IOP and HPD values than cats in TZA0 group in the period between 10 and 30min. According to the results, unlike the TZ combination in dogs, TZ (12 mg/kg, IM) would significantly decrease IOP and caused slightly miosis in cats. Intramuscular administration of 0.02 mg/kg and 0.04 mg/kg atropine would cause mydriasis in cats, which was offset by the effect of TZ in our study. Consequently, TZ or TZ with 0.02-0.04 mg/kg atropine sulfate have statistically but not clinically significant influence on the IOP and HPD, and may serve as a safety anesthetic protocol when an increase of IOP is undesirable.

摘要 i
Abstract ii
目次 iii
表次 v
圖次 vi
第一章 緒言 7
第二章 文獻探討 8
第一節 眼房水以及眼壓 8
一、 眼房水的組成及製造 8
二、 眼房水的排除 9
三、 眼壓的測量 10
四、 影響眼壓的生理因素 11
第二節 虹彩及瞳孔 15
第三節 麻醉與眼壓的關係 16
一、 麻醉對眼壓的影響 16
二、 麻醉劑、止痛劑、及其他輔助藥物對於眼壓的影響 16
第四節 藥物介紹 21
一、 Tiletamine 21
二、 Zolazepam 22
三、 Tiletamine-zolazepam (TZ) 23
第三章 實驗材料與方法 26
第一節 實驗材料 26
一、 動物來源 26
二、 器材與耗材 26
第二節 實驗方法 27
一、 建立基本資料 27
二、 眼科學檢查 27
三、 麻醉與數據蒐集 29
第三節 統計學分析 30
第四章 實驗結果 31
第一節 基本資料 31
第二節 眼壓及瞳孔基礎值比較 34
一、 兩眼間比較 34
二、 性別間比較 34
三、 不同時間點比較 35
四、 緊迫程度 36
五、 組別間比較 37
第三節 麻醉後眼壓及瞳孔大小變化 38
一、 麻醉後眼壓變化 38
二、 麻醉後瞳孔大小變化 40
麻醉後其他生理數值變化 42
三、 心跳次數 42
四、 收縮壓 43
五、 平均動脈壓 44
六、 呼吸次數 45
七、 體溫 46
第五章 討論 47
參考文獻 53


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