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研究生:蔡依津
研究生(外文):Yi-Chin Tsai
論文名稱:犬隻以Propofol全靜脈麻醉臨床應用之評估
論文名稱(外文):A Clinical Comparative Study of Propofol Total Intravenous Anesthesia (TIVA) in Dogs
指導教授:葉力森葉力森引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:獸醫學研究所
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:2005
畢業學年度:93
語文別:中文
論文頁數:83
中文關鍵詞:全靜脈麻醉氣體麻醉比較
外文關鍵詞:propofolisofluranedogstotal intravenous anesthesiacomparative
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第一部份
犬隻以propofol全靜脈麻醉臨床應用之評估〈術中分析比較〉

271隻需要進行全身麻醉的畜主飼養犬隻,麻醉風險從輕微到嚴重不等,隨機進行以propofol全靜脈麻醉,或propofol誘導後接著isoflurane維持的麻醉。比較犬隻在兩者維持麻醉中,有何差異。

研究發現,接受propofol全靜脈麻醉的犬隻在手術當中的心跳及血壓較isoflurane維持的麻醉來的高,這種情形在麻醉風險較高的族群較為明顯。而犬隻使用propofol全靜脈麻醉進行有關鼻腔刺激的診斷手術時,既使給予更多的麻醉劑量,仍會出現抗拒的抬頭反應,推測其可能提供較低的麻醉深度。麻醉後放置氣管插管之後到犬隻恢復第一次自發呼吸的時間,使用propofol全靜脈麻醉的犬隻費時較長。接受propofol全靜脈麻醉中有五犬隻在麻醉中出現類似全身性抽慉的現象,此神經症狀於人醫有被報告過。

因此建議,若期望犬病患於麻醉中心肺功能不被抑制太嚴重,則可以優先考慮propofol全靜脈麻醉,但是有關鼻腔的手術與操作則不建議使用。以propofol全靜脈麻醉仍要注意呼吸抑制以及可能的類似全身抽搐現象。


第二部份
犬隻以propofol全靜脈麻醉臨床應用之評估〈術後分析比較〉

149隻需要進行全身麻醉的畜主飼養犬隻,麻醉風險從輕微到嚴重不等,隨機進行以propofol全靜脈麻醉,或propofol誘導後接著isoflurane維持的麻醉。比較犬隻在兩者麻醉恢復中,有何差異。

麻醉恢復的比較依照三種不同的狀況做評估:恢復的快慢、恢復時的平順度,以及恢復時出現的副作用。研究發現,propofol全靜脈麻醉提供了較佳的恢復平順度,但從移除氣管插管漸漸恢復至行走所花費時的時間較長,兩組麻醉恢復時發生副作用(神經症狀、嘔吐,及過度流涎)的頻率相似。過去鮮少被報告的過度流涎副作用在本研究中佔有20.8 %的比例。

因此建議,若期望犬病患在麻醉恢復時能有最平順的甦醒,則可以優先考慮propofol全靜脈麻醉。在麻醉維持中使用propofol全靜脈麻醉並不會因為犬隻接受較多的propofol而在恢復時有更多的神經症狀出現。
<Part-1>
A Clinical Comparative Study of Propofol Total Intravenous Anesthesia in Dogs

Propofol total intravenous anesthesia (TIVA) was compared with a well established propofol induced, isoflurane maintained anesthesia in 271 client-owned canine patients of variable anesthetic risks. Dogs anesthetized with propofol TIVA showed generally higher values of heart rate and systemic blood pressure, especially in patients with greater anesthetic risks. Propofol TIVA appeared to offer lighter level of anesthesia which precludes its application in procedures eliciting nasal passage stimulation. The time to first regain spontaneous breathing after induction was significantly longer in dogs maintained with propofol. Uncommon seizure-like tremor episodes during propofol infusion were also observed in the study.


<Part-2>
The Recovery Profiles of Propofol Total Intravenous Anesthesia in Dogs

Objective
To compare the recovery of propofol total intravenous anesthesia (TIVA) and propofol induced, isoflurane maintained anesthesia in clinical canine cases.

Study design
Prospective, randomized clinical study

Animals
One hundred and forty-nigh clients-owned dogs

Materials and methods
Dogs requiring general anesthesia for surgical or diagnostic procedures (gastrointestinal surgeries excluded) were randomly assigned to two groups of different anesthetic maintenance regimens including (1) isoflurane inhalational anesthesia with oxygen after propofol induction (Isoflurane group), and (2) propofol TIVA with oxygen supplement (TIVA group). The smoothness, speed and adverse effects of anesthetic recovery were recorded and compared statistically between the two groups.

Results
The smoothness of anesthetic recovery in the TIVA group was significantly better than the Isoflurane group. However, dogs in the Isoflurane group recovered generally faster than the TIVA group. Adverse effects were observed in 31 of 91 dogs (34%) in the Isoflurane group and 18 of 58 dogs (31%) in the TIVA group, with no statistical difference. Postoperative hypersalivation was commonly observed in both groups and had never been reported before. The incidence of neurological signs during recovery was similar in both groups.

Conclusions
Propofol TIVA provided smoother but slower recovery compared with propofol induced, isoflurane maintained anesthesia. Adverse effects were similar in both protocols. The accumulated propofol dosage with total intravenous maintenance did not further predispose the dogs to more neurological disorders. Post-operative hypersalivation was commonly noticed after propofol administration.


Clinical relevance
Controlled laboratory canine model had been used to study propofol maintained anesthesia. However, systemic clinical research of dogs under propofol TIVA was still lacking. The understanding of the recovery profiles of propofol TIVA under clinical setups is important to practitioners who use this protocol as an option of general anesthesia.
第一章 序 言………………………………………………………1

第二章 文獻探討………………………………………………………2
第一節 獸醫麻醉的相關歷史………………………………..2
第二節 靜脈麻醉藥物………………………………………..3
第三節 全靜脈麻醉…………………………………………..4
第四節 靜脈麻醉藥propofol…………………………………6
簡介……………………………………..……………6
藥物動力特性…………………………..……………6
對心血管系統的影響…………………..……………7
對呼吸系統的影響……………………..……………8
對體溫的影響…………………………..……………9
與其有關的神經症狀…………………..…………..10
類癲癇現象(seizure-like phenomena, SLP)….…11
對腦壓的影響……………………………………....11
止吐的作用…………………………………………12
第五節 Propofol於獸醫的臨床應用………………..………13
使用於誘導麻醉…………………………..………..13
使用於維持麻醉……………………………..……..14
第六節 Propofol全靜脈麻醉使用的現況……………..……15
人醫……………..…………………………………..15
獸醫…………………………………..……………..15
第七節 研究目的…………………..………………………..19
第三章 參考文獻……………………………………………………..21

第四章 犬隻以propofol全靜脈麻醉臨床應用之評估
〈術中分析比較〉…………………………………………..29
一. 中文摘要……………………………………………...30
二. 英文摘要(Abstract)…………………………………31
三. 前言(Introduction)…………………………………32
四. 材料與方法(Materials and methods)………………34
五. 結果(Results)……………………………………….37
六. 討論(Discussions)………………………………….40
七. 結論(Conclusions)…………………………………45
八. 附圖(Figures)……………………………………….46
九. 附表(Tables)………………………………………..55
十. 參考文獻(References)……………………………..57

第五章 犬隻以propofol全靜脈麻醉臨床應用之評估
〈術後分析比較〉…………………………………………..60
一. 中文摘要……………………………………………...61
二. 英文摘要(Abstract)………………………………..62
三. 前言(Introduction)………………………………….65
四. 材料與方法(Materials and methods)………………67
五. 結果(Results)……………………………………….71
六. 討論(Discussions)………………………………….73
七. 結論(Conclusions)…………………………………77
八. 附表(Tables)……………………………………….78
九. 參考文獻(References)……………………………..81

附錄一. 實驗用麻醉紀錄表
Antonio JA Aguiar, Stelio PL Luna, Val
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