不同剂量瑞芬太尼喉罩通气麻醉对老年患者全髋关节置换术的影响

Effects of different dose of remifentanil with laryngeal mask airway ventilation on total hip-arthroplasty in the aged patients

目的观察并比较老年患者双腔型喉罩麻醉下行全髋关节置换术中应用不同剂量瑞芬太尼的临床效果。方法选择择期行全髋关节置换术的老年患者60例，ASA分级Ⅰ～Ⅱ级，根据瑞芬太尼的不同剂量，分为0．2μg／（kg·min）组、0．3I．Lg／（kg·min）组与0．4μg／（kg·min）组，每组20例。记录三组患者麻醉诱导前、麻醉诱导后即刻、置喉罩后即刻、手术开始、术中15min、停麻醉药的平均动脉压（MAP）和心率，以及术中用药、体动发生率与苏醒时间。结果所有患者均顺利完成手术，无术中知晓发生。0．2μg／（kg·min）组术中心率、MAP波动大，体动发生率高（45．0％，9／20），丙泊酚使用量最多[（82．4±21．6）mg]；0．3μg／（kg·min）组术中心率、MAP波动较小，术后患者苏醒较快；O．4μg／（kg·min）组术中心率、MAP抑制作用明显，麻黄碱使用量最大[（5．2±4．3）mg]，术后拔喉罩时间长[（5．2±1．3）min]。结论0.3μg／（kg·min）瑞芬太尼复合丙泊酚行双腔型喉罩通气可用于全髋关节置换术老年患者的全凭静脉麻醉，血流动力学稳定，并发症少，通气可靠。

Objective To investigate the clinical effects of different dose of remifentanil with double-tube type laryngeal mask airway （LMA） ventilation in the aged patients undergoing total hip-arthroplasty （THA）. Methods Sixty ASA class Ⅰ～Ⅱ grade patients undergoing THA were enrolled in the study. The patients were divided into three groups according to remifentanil dose with 20 cases each, 0.2 μg/ （kg· min） group,0.3 μg/（kg·min） group and 0.4 μg/（kg·min） group. Heart rate and mean arterial pressure （MAP） were measured immediately before anesthesia induction, immediately after anesthesia induction, immediately after inserting LMA, the set of operation, 15 min during operation and discontinuation of anesthetic. Results All patients were successfully operated without intraoperative awareness. In 0.2 μg/（ kg ·min ） group,the patients suffered from the heart rate and MAP fluctuations, the high incidence of body movement （45.0%, 9/20）, and the maximum amount of propofol [ （82.4 ± 21.6） mg ]. In 0.3μg/（kg· min） group, heart rate and MAP had the better fluctuation, and patients might wake up faster postoperatively. In 0.4 μg/（kg· min ） group, heart rate and MAP significantly decreased, the amount of efedrina [ （5.2±4.3 ） mg ] was the largest in the three groups, the recovery time [ （5.2 ± 1.3） min] was the longest. Conclusion Remifentanil 0.3 μ g/（kg·min） compound with propofol with double-tube type LMA can be used for total intravenous anesthesia in the elderly patients with THA, with hemodynamic stability, fewer complications, and reliable ventilation.