静脉注射异丙酚复合瑞芬太尼对急诊肩关节复位手术的效果观察

Observation on Effect of Intravenous Propofol and Remifentanil for Emergency Reduction of Shoulder Dislocation

【目的】观察静脉注射异丙酚复合瑞芬太尼在急诊肩关节复位手术中的效果。【方法】选择13例急诊需行肩关节复住患者，以异丙酚0．5mg／kg复合瑞芬太尼0．5μg／kg静注，静注时间在90s以上。如需要则追加0．25mg／kg异丙酚和0．25μg／kg瑞芬太尼。手术医师采用Hippocrates法进行复位。【结果】所有患者成功复位时间都在4min以内（0．3～4min，平均在1．6min），10个一次复位成功，2个2次复位成功，1个需要3次才复位成功。到恢复手术前状态平均时间是3min（1～6min）。复位期间患者疼痛评分（VAS评分）平均分是1．8（0～5）。10个患者能够回忆整个过程，2个患者能够部分回忆，1个患者对整个过程无印象。13个患者中有10个患者对麻醉效果和复位操作影响非常满意。剩下的3个患者对此也感到满意。在复位的患者中没有呼吸和循环抑制的并发症出现。【结论】静脉异丙酚复合瑞芬太尼对肩关节复住手术能够提供良好的镇痛和镇静作用，且能快速使患者恢复。

[Objective]To assess the effect of combination of intravenous propofol and remifentanil for emergency reduction of shoulder dislocation. [Methods]Thirteen patients with shoulder dislocation were given propofol 0. 5 mg/kg and remifentanil 0. 5rog/kg intravenously for over 90 seconds, and boosted propofol 0. 25mg/kg and remifentanil 0.25μg/kg if needed. Surgeons underwent the reduction by the Hippocrates technique. [Results]The reduction was successfully achieved in all patients within four minutes（0.3-4 minutes, mean I. 6minutes）. Ten patients had the reduction for the first time, two for twice,and one for three times. The mean time of recovery was three minutes（1-6 minutes）. The mean pain score （VAS score） during the reduction was 1.8 （0-5）. Ten of them had full recall,two had partial recall, and one had no recall at all. All the ten patients were very satisfied with the effect and the other three patients were satisfied. There were no respiratory or haemodynamic complications that required treatment. [Conclusion] Propofol and remifentanil provide excellent sedation and analgesia for the reduction of shoulder dislocation, and have the rapid recovery of patients.