丙泊酚复合瑞芬太尼全静脉麻醉在骨科手术中的临床研究

Propofol Combined Remifentanil for Total Intravenous Anesthesia in Orthopedic Surgery

目的观察丙泊酚复合瑞芬太尼全静脉麻醉在骨科手术中的临床效果。方法选择择期需全麻下行骨科(下肢及髋关节)手术的患者260例,随机分成A组和B组各130例。A组麻醉诱导(丙泊酚1.0mg/kg+瑞芬太尼1.5μg/kg)、麻醉维持[丙泊酚(4～8)mg/(kg.h)+瑞芬太尼(0.1～0.8)μg/(kg.min)];B组则为麻醉诱导(丙泊酚1.0mg/kg+瑞芬太尼1.5μg/kg)、麻醉维持[丙泊酚(4～8)mg/(kg.h)+芬太尼0.15μg/(kg.min)。分别观察插管前、插管后、手术开始时、手术结束时的心率(HR)、血压(SBP、DBP)及术中疼痛反应。记录患者苏醒时间、拔管时间、拔管后镇静评分、丙泊酚用量、不良反应。结果插管前后、手术过程中,A组的SBP和DBP值较B组低(P<0.05);B组患者苏醒和拔管所需时间明显较A组长,B组麻醉过程所需丙泊酚的量较A组多(P<0.05)。两组间拔管后的镇静得分无统计学差异(P>0.05),术中均无疼痛反应,且不良反应发生率均较低。结论丙泊酚复合瑞芬太尼用于全静脉麻醉安全、有效,适用于骨科手术。

Objective To explore the clinical usage of propofol combined with remifentanil for total intravenous anesthesia in orthopedic surgery. Methods 260 patients were randomized into two groups（group A and B,n=130 in each group）. Propofol 1.0mg/kg and remifentanil 1.5 μ g/kg were used for anesthesia induction and then propofol （4 - 8 ）mg/（kg· h） and remifentanil （0.1 - 0.8 ） μ g/（kg·min） were used during the maintaining in A group. Propofol 1.0mg/kg and 1.5μg/kg of fentany were used for anesthesia induction and then propofol （4 -8）mg]（kg·h） and 0.15μg/（kg·min） were used during the maintaining in B group. HR,SBP,DBP before and after tracheal intubation and operation,pain reaction were record, as well as the waking time, OAAS, the total dosage of propofol and adverse reaction. Results Before and after tracheal intubafion, and during the operation,the value of SBP and DBP were lower in A group than in B group （P〈0.05）.The time for patiens to wake up and tube drawing was longer in B group than in A group,and the total dosage of propofol was used much more in B group （P〈0.05）. However,the scores of OAAS were almost the same,and no pain reaction appeared in the two groups. In addition,the incidence of adverse reaction was relatively low. Conclusion Propofol combined remifentanil is safe and effective in total intravenous anesthesia in orthopedic surgery .