骨科手法复位应用丙泊酚复合小剂量芬太尼麻醉效果观察

The Anesthetic Efficiency of Propofol Combined with a Small Dosage of Fentanyl in Orthopedic Manipulative Reduction

目的观察骨科手法复位应用丙泊酚复合小剂量芬太尼的麻醉效果。方法选择2007年1月-2009年8月在我院就诊的急性肩、髋关节脱位或长管骨闭合性骨折60例,随机分为治疗组和对照组,每组30例。对照组以2 mg/（kg.min）的速率静脉注射丙泊酚至患者睫毛和指令性反射消失,复位开始。若出现疼痛叫喊或抵抗,追加适量丙泊酚至复位结束。治疗组在丙泊酚诱导前先静脉注射芬太尼50μg,丙泊酚用法、用量同对照组。记录两组丙泊酚首剂用量和总剂量,全程监测平均动脉压（MAP）、心率、脉搏氧饱和度（SpO2）变化。并按照麻醉效果三级评定法记录两组各级例数和患者出现的不良反应情况。结果两组复位手法相同,MAP、心率与麻醉前比较均明显下降,但组间比较差异无统计学意义（P〉0.05）。两组SpO2〈0.90发生率、苏醒时间比较差异无统计学意义（P〉0.05）。治疗组丙泊酚首剂用量及总剂量均少于对照组,麻醉有效率高于对照组,差异有统计学意义（P〈0.05）。对照组术中无呕吐发生,恶心4例,谵妄2例,清醒后头痛、头晕3例;治疗组轻度头痛2例,均无需特殊处理。结论丙泊酚复合小剂量芬太尼用于大关节脱位及长管骨闭合性骨折手法复位不失为一种安全有效、理想的麻醉方法。

Objective To observe the anesthetic efficiency of anesthesia with propofol combined with a small dosage of fentanyl in orthopedic manual reduction.Methods 60 patients with acute dislocation of shoulder joint and hip joint or acute closed fracture of tube bone were randomly divided into 2 groups with 30 subjects in each group.The control group received intravenous propofol at the speed of 2 mg/（kg·min） until eyelash and commanded reflexes disappeared and manual reposition began.The patients were given a moderate more dosage of propofol during the operation if the patients screamed or struggled.The treatment group was given additional 50 μg fentanyl before induced.Application of the first dosage and total dosage of propofol was observed.MAP,HR and SpO2 were continuously monitored during the operation,and the anesthetic effect and adverse reaction were observed.Results Both MAP and HR descended significantly in two groups and there was no significant difference between them（P0.05）.Incidence of SpO20.90 and the time of resuscitation had no significant difference（P0.05）.The first and total dosages of propofol in treatment group were less than that in control group,while the anesthesia efficiency rate was higher in treatment group than in control group,and the difference showed statistically significant（P0.05）.During the operation there was no vomiting,4 cases of nausea,2 cases of deliration and 3 cases of headache or dizziness in control group;there were 2 cases of mild headache in treatment group,with no need for special treatment.Conclusion It is an effective and safe anesthesia mode with propofol combined with a small dosage of fentanyl in manual reduction in the treatment of acute dislocation of shoulder joint and hip joint and acute closed fracture of tube bone.