SLIPA喉罩吸入七氟烷联合地佐辛在骨科四肢手术中的应用

Application of sevoflurane inhalation by the streamlined liner pharynx airway laryngeal mask combined with dezocine in orthopaedics surgery

目的评价地佐辛复合七氟烷喉罩吸入行骨科四肢手术的可行性及安全性。方法拟行骨科短小手术60例,随机分为芬太尼组(F组)和地佐辛组(D组),给予咪达唑仑同时以七氟烷麻醉诱导、维持,F组芬太尼0.002 mg/kg,D组地佐辛0.01 mg/kg稀释至10 mL静脉注射;快速使患者进入麻醉状态并插入SLIPA喉罩,观察记录麻醉开始诱导时(T1)、置入喉罩时(T2)、手术切皮时(T3)、手术缝皮时(T4)、拔除喉罩时(T5)及术后0.5、1、2 h等各个时点的BP、HR、SpO2。并记录两组患者开始诱导至睫毛反射消失时间Ta、开始诱导至置入喉罩时间Tb、手术结束至拔除喉罩时间Tc。观察两组患者术后Ramsay镇静程度评分(RSS)、镇痛评分(VAS)、躁动评分(RS)。及头晕、恶心呕吐等不良反应情况。结果手术结束至拔除喉罩时间Tc:D组早于F组差异有统计学意义(P<0.05)。术后0.5 h镇静程度评分(RSS):F组高于D组,差异有统计学意义(P<0.05)。镇痛评分(VAS):术后0.5、1、2 h各时点F组均高于D组,差异有统计学意义(P<0.05);躁动评分(RS):术后0.5、1 hF组高于D组,差异有统计学意义(P<0.05)。结论 SLIPA喉罩吸入七氟烷联合地佐辛增强麻醉效果,安全平稳,苏醒完全,减少术后疼痛、烦躁等并发症,在骨科短小手术中可选择应用。

Objective To evaluate the feasibility and safety of sevoflurane inhalation by the streamlined liner pharynx airway（SLPA） laryngeal mask combined with dezocine in orthopaedics surgery.Methods Sixty patients who underwent short orthopaedic surgery were randomly divided into fentanyl group（group F） and dezocine group（group D）.They received midazolam with sevoflurane narcotic induction and maintenance of surgery.Patients in group F received fentanyl（0.002 mg/kg）,and those in group D received dezocine（0.01 mg/kg） dilution to 10 mL by intravenous infusion.Patients rapidly went into the anesthesia state and SLIPA laryngeal mask was then inserted.BP,HR,SpO2 were recorded during beginning of anesthesia induction（T1）,placement of laryngeal mask（T2）,operation cut skin（T3）,operation seam skin（T4）,pulling out of laryngeal mask（T5） and postoperative time points of 0.5 h,1 h,2 h.The time of two groups was recorded during starting induction to abolition of eyelash reflex（Ta）,starting induction to put into induced laryngeal mask time（Tb） and post-operation to pull out laryngeal mask time（Tc）.After operation,the two groups were observed in terms of Ramsay sedation score（RSS）,visual analgesic score （VAS）,restless score（RS）,and adverse events such as dizziness,nausea and vomiting.Results Tc was earlier in group D than in group F,and the difference was statistically significant（P〈0.05）.Half an hour after surgery,RSS was higher in group F than in group D,and the difference was statistically significant（P〈0.05）.At postoperative time points of 0.5 h,1 h and 2 h,VAS was higher in group F than in group D,and the difference was statistically significant（P〈0.05）.At postoperative time points of 0.5 h,1 h and 2 h,RS was higher in group F than in group D,and the difference was statistically significant（P〈0.05）.Conclusion Sevoflurane inhalation by SLPA laryngeal mask combined with dezocine in orthopaedics surgery enhances anesthesia effect and has advantages of safety,complete revival of anesthesia, and less complications such as postoperative pains and restlessness.Thus it can be selectively used in short orthopaedic surgery.