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研究生: 黃泓康
Huang, Hung-Kang
論文名稱: 評估Gabapentin, Buprenorphine及Dexmedetomidine於貓隻眼科學檢查之影響及作為子宮卵巢摘除術術前給藥之效用
Evaluation of the Effects of Gabapentin, Buprenorphine, Dexmedetomidine on Ocular Examination, and as a Premedication Drug in Cats Undergoing Ovariohysterectomy
指導教授: 鍾承澍
Chung, Cheng-Shu
學位類別: 碩士
Master
系所名稱: 獸醫學院 - 獸醫學系所
Department of Veterinary Medicine
畢業學年度: 109
語文別: 中文
論文頁數: 62
中文關鍵詞: 鎮靜眼科檢查止痛抗焦慮
外文關鍵詞: gabapentin, buprenorphine, sedation, ophthalmic examination, analgesia
DOI URL: http://doi.org/10.6346/NPUST202100451
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  • 鎮靜可能會影響到動物的眼科檢查結果,然而針對會主動攻擊或是容易緊張的貓隻,檢查時給予適當的鎮靜是有幫助的,此外術前的鎮靜給藥也可增加術後恢復的品質及止痛的效果。近年來發現口服gabapentin及經口腔粘膜給予buprenorphine、dexmedetomidine對於貓隻可提供良好的鎮靜效果,並具有高安全性及便利性的特性,因此本研究的目的是評估口服gabapentin及經口腔粘膜給予buprenorphine、dexmedetomidine對眼科檢查這些檢查的影響,同時也對探討這些藥物作為子宮卵巢切除術術前給藥之效用。本研究的對象為麻醉風險等級一到二級且沒有眼科異常的貓隻,隨機分配成四組,每組10隻貓,分別給予單次劑量藥物:安慰劑 (CG)、gabapentin (GG, 100 mg/cat, PO)、buprenorphine (BG, 0.04 mg/kg, OTM)或dexmedetomidine (DG, 7.5 μg/ kg, OTM);分別於藥物作用前後進行眼內壓 (IOP)、淚液分泌量 (STT-I)、瞳孔直徑 (PD)的測量,經子宮卵巢摘除術後,記錄每隻貓拔除氣管內插管後0.5、1、2和4小時的緊迫反應分數、鎮靜分數、疼痛分數、呼吸速率、心跳速率和平均動脈壓。結果顯示DG組在給予藥物後STT-I出現顯著下降;BG組的PD顯著增加。除CG組外,所有組別術後都表現出顯著的抗緊迫作用。GG組有2隻(2/10, 20%)、DG組有4隻(4/10, 40%)、BG組則有1隻(1/10, 10%)需要術後額外追加止痛,而在CG組則不需要另外追加止痛(0/10, 0%)。根據本研究結論,口服gabapentin(100 mg/cat, PO)可以發揮安全有效的抗緊迫效果,能避免貓隻因緊迫恐懼所導致的反抗攻擊行為,對貓隻是適合的眼科檢查前鎮靜藥物。對於術後止痛效果雖無buprenorphine IV術前給藥效果好,但能使術前血管留置針放置的操作較易施作。

    Although the sedation may alter the results of ocular examination in animals, it is still inevitable for aggressive or stressful cats. Moreover, the adoption of sedation procedure prior to surgery could improve the recovery quality and analgesia effects during postoperative period. Recently, the appropriate sedative effects were shown by oral gabapentin, and oral transmucosal administration (OTM) of buprenorphine or dexmedetomidine in cats. The characteristics of high safety and convenience were also noted. Therefore, the aim of the study is to evaluate the effects on ocular examination afterof oral gabapentin, and OTM of buprenorphine or dexmedetomidine in cats. Besides, the effects of these medication were evaluated after ovariohysterectomy as well. ASA I–II cats without ophthalmic abnormalities were enrolled. The cats were randomly assigned and administered one of four single-dose treatments: placebo (CG), gabapentin capsules (GG, 100 mg/cat, PO), buprenorphine (BG, 0.04 mg/kg, OTM) or dexmedetomidine (DG, 7.5 μg/ kg, OTM). Intraocular pressure (IOP), Schirmer’s tear test (STT-I), Pupil diameter (PD) were evaluated before and after the medicine onset. The fear responses, sedation level, pain score, respiratory rate (RR), heart rate (HR) and blood pressure (MAP) were scored at 0.5 h, 1 h, 2 h and 4 h after extubation. Forty cats were recruited. Results indicated that STT-I showed a statistically significant reduction in DG; PD was significant increasing in BG. Except CG, all treatment groups displayed notable sedation and anti-stress effect. Four (4/10, 40%) cats in DG, two (2/10, 20%) in GG, one (1/10, 10%) in BG, and 0(0/10, 0%) in CG required rescue analgesia after surgery. This study concludes that oral gabapentin, which induced a safe and stress reducing effect, and avoided the act of resisting attack caused by the cat's urgent fear, is an appropriate sedative medication for cats prior to an ocular examination if necessary. Although the postoperative analgesia results of oral gabapentin was lower than intravenous buprenorphine, it makes the placement of peripheral intravenous catheter prior to surgery easier.

    摘要………………………………………………………………………………………………………………i
    Abstract………………………………………………………………………………………………iii
    謝誌………………………………………………………………………………………………………………v
    目錄……………………………………………………………………………………………………………vi
    圖目錄………………………………………………………………………………………………………ix
    表目錄…………………………………………………………………………………………………………x
    1. 前言………………………………………………………………………………………………1
    2. 文獻探討……………………………………………………………………………………3
    2.1 Gabapentin………………………………………………………………………3
    2.1.1 藥理機制……………………………………………………………………………3
    2.1.2 臨床使用範圍……………………………………………………………………4
    2.2 Dexmedetomidine…………………………………………………………6
    2.2.1 藥理機制……………………………………………………………………………6
    2.2.2 臨床使用範圍…………………………………………………………………7
    2.3 Buprenorphine…………………………………………………………………8
    2.3.1 藥理機制………………………………………………………………………………8
    2.3.2 臨床使用範圍……………………………………………………………………8
    2.4 眼科學檢查與鎮靜藥物之相關研究……………………………9
    2.4.1 α-2腎上腺素受體致效劑……………………………………………10
    2.4.2 類鴉片類藥物…………………………………………………………………10
    2.4.3 Alfaxalone……………………………………………………………………10
    2.4.4 phenothiazines類藥物……………………………………………11
    2.4.5 解離型麻醉劑…………………………………………………………………11
    2.4.6 benodiazepines類藥物……………………………………………11
    2.5 鎮靜反應………………………………………………………………………………11
    2.5.1 作用機制……………………………………………………………………………11
    2.5.2 常見鎮靜藥物………………………………………………………………12
    2.5.3 鎮靜評估…………………………………………………………………………12
    2.6 疼痛反應……………………………………………………………………………13
    2.6.1 作用機制…………………………………………………………………………13
    2.6.2 疼痛控制…………………………………………………………………………13
    2.6.3 疼痛評估…………………………………………………………………………14
    2.7 緊迫反應……………………………………………………………………………15
    2.7.1 作用機制…………………………………………………………………………15
    2.7.2 常見抗緊迫藥物……………………………………………………………16
    2.7.3 緊迫評估…………………………………………………………………………17
    3. 材料與方法……………………………………………………………………………18
    3.1 實驗材料……………………………………………………………………………18
    3.1.1 動物來源…………………………………………………………………………18
    3.1.2 器械及耗材……………………………………………………………………18
    3.2 檢查項目……………………………………………………………………………19
    3.2.1 基礎檢查…………………………………………………………………………19
    3.2.2 實驗室檢驗……………………………………………………………………19
    3.2.3 眼科學檢查……………………………………………………………………19
    3.3 評分表…………………………………………………………………………………21
    3.3.1 鎮靜評分…………………………………………………………………………21
    3.3.2 貓隻急性緊迫評分………………………………………………………23
    3.3.3 疼痛評分…………………………………………………………………………23
    3.4 實驗流程……………………………………………………………………………25
    3.4.1 手術前……………………………………………………………………………25
    3.4.2 手術……………………………………………………………………………………25
    3.4.3 手術後………………………………………………………………………………26
    3.5 分析與統計………………………………………………………………………26
    4. 結果……………………………………………………………………………………………27
    4.1 基本統計資料結果……………………………………………………………27
    4.2 於藥物作用前後造成眼科學檢查之影響、鎮靜及抗緊迫效果評估、生理數值影響之結果…………………………………………………………………………………27
    4.2.1 各組藥物作用前後對眼科學檢查之影響……………27
    4.2.2 各分組於藥物作用後鎮靜效果之評估………………29
    4.2.3 各分組於藥物作用後緊迫評分之差異………………30
    4.2.4 各分組於藥物作用後生理數值之變化………………31
    4.2.5 眼壓與血壓的相關性……………………………………………………33
    4.3 手術結束移除插管後,各藥物組別於不同時間點鎮靜、抗緊 迫及疼痛反應之評估結果……………………………………………………………………34
    4.3.1 比較各組鎮靜效果於術後時間之變化…………………34
    4.3.2 各分組於術後抗緊迫效果之影響……………………………35
    4.3.3 各組藥物於手術後止痛之效用…………………………………36
    4.3.4 各分組於術後各時間點生理數值之變化………………38
    4.4 恢復時間…………………………………………………………………………………41
    4.5 評估各組貓隻於投予藥物後是否有不良反應…………42
    5. 討論……………………………………………………………………………………………43
    6. 結論……………………………………………………………………………………………50
    參考文獻……………………………………………………………………………………………………51

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