丙泊酚瑞芬太尼静脉全麻与七氟烷瑞芬太尼静吸复合全麻在老年患者骨关节置换术中的麻醉比较

Anesthetic comparison between total intravenous anesthesia with remifentanil and propofol and intravenous inhalational anesthesia with remifentanil and sevoflurane in elderly patients undergoing joint replacement surgery

目的比较丙泊酚瑞芬太尼静脉全麻与七氟烷瑞芬太尼静吸复合全麻这两种常用麻醉方式应用于老年患者骨关节置换术的优劣。方法 ASAⅡ～Ⅲ级行骨关节置换术的老年患者(60～75岁)60例,随机分为丙泊酚瑞芬太尼静脉全麻组(A组)与七氟烷瑞芬太尼静吸复合组(B组),A组采用丙泊酚靶控输注复合瑞芬太尼实现麻醉维持,B组采用七氟烷吸入加瑞芬太尼泵注实现麻醉维持。比较两组患者血流动力学相关指标和术后苏醒时间。结果 A组患者收缩压(SBP)、心率(HR)变化均小于B组(P<0.05)。A组患者吞咽反射恢复时间、术后清醒时间、拔除气管导管时间及出麻醉恢复室(PACU)时间均比B组缩短(P<0.01)。结论丙泊酚瑞芬太尼静脉全麻组麻醉维持更平稳,术后苏醒更迅速,该全麻可以更好的应用于行骨关节置换术的老年患者。

Objective To compare the anesthetic superority of total intravenous anesthesia with remifentanil and propofol and intravenous inhalational anesthesia with remifentanil and sevoflurane in elderly patients undergoing joint replacement surgery. Methods 60 elderly patients （aged 60-75,ASA Ⅱ-Ⅲ grade） undergoing hip-joint replacement surgery were randomly received total intravenous anesthesia with remifentanil and propofol （A group ;n = 30）and intravenous inhalational anesthesia with remifen- tanil and sevoflurane（ B group ;n = 30）. The systolic blood pressure （SBP）, heart rate （HR）, swallowing reflex recovery time, postoperative awaking time, extubation time and post-anesthesia care unit time were evaluated in two groups. Results Compared with B group, the variation of SBP and HR in A group was far less （ P 〈 0. 05 ） , and the swallowing reflex recovery time, postoper- ative awaking time, extubation time and post-anesthesia care unit time in A group was significantly shorter （P 〈 0. 01 ）. Conclu- sion Total intravenous anesthesia with remifentanil and propofol may represent a better anesthetic strategy in elderly patients un- dergoing joint replacement surgery.