七氟醚复合瑞芬太尼麻醉在老年患者肩关节脱位中的临床观察

Therapeutic effect of combined sevoflurane and remifentanil anaesthesia on shoulder dislocation in elderly patients

目的 探讨七氟醚复合瑞芬太尼在老年患者肩关节脱位中的应用及其效果. 方法 将100例老年肩关节脱位患者随机地均分为对照组与观察组,各50例.对照组采用单纯瑞芬太尼麻醉,观察组采用七氟醚复合瑞芬太尼联合麻醉,比较2组患者的临床疗效及麻醉后患者的生活质量及加州大学肩关节评分系统（UCLA）功能得分等. 结果 对照组优良率为68.0％,小于观察组的92.0％（x2=9.03,P=0.011）；平均动脉压、心率、血氧饱和度麻醉后对照组分别为（86.3±3.0） mmHg、（83.2±4.5）次/min、（94.4±5.5）％,观察组分别为（83.1±2.5） mm Hg、（81.1±4.0）次/min、（92.0±6.0）％（t=5.79、2.47、2.09,均P＜0.05）；对照组麻醉起效时间、手术时间、恢复时间及离院时间分别为（26.6±6.6、4.6±2.1、4.9±2.3、205.5±121.1）min,观察组分别为（5.1±1.3、2.3±1.2、2.8±1.1、121.3±89.3） min（t=22.60,6.72,5.82,3.96,均P＜0.01）；生活质量得分麻醉后观察组（131±7）分,优于对照组（109±6）分（t=16.87,P=0.000）；麻醉后UCLA功能观察组得分（32±4）分,高于对照组（26＋3）分（t=8.49,P=0.000）. 结论 七氟醚复合瑞芬太尼在老年患者肩关节脱位中的临床疗效尤佳,麻醉后患者生活质量提高.

Objective To explore the effects of combined sevoflurane and remifentanil on shoulder dislocation in elderly patients.Methods A total of 100 elderly patients with shoulder dislocation were randomly divided into the control group and the observation group （n =50,each group）.The control group was anaesthetized with remifentanil and the observation group was anaesthetized with sevoflurane and remifentanil.The clinical efficacy of anaesthesia,life quality and the University of California at Los Angeles （UCLA） shoulder rating scale were recorded.Results The excellent rate of anaesthesia was higher in observation group than in control group （92.0% vs.68.0%,x2 =9.033,P=0.011）.There were significant differences in mean arterial pressure （MAP）,heart rate （HR） and arterial pulse oxygen saturation （SpO2） between the control and the observation group after anaesthesia [（86.3±3.0） mm Hg vs.（83.1±2.5） mm Hg,（83.2±4.5） times/min vs.（81.1±4.0） times/min,（94.4±5.5）% vs.（92.0±6.0）%,respectively,t=5.794,2.466,2.085,all P〈0.05].There were significant differences in the onset time of anesthesia,surgery time,recovery time,and hospital stay days between the control and the observation group [（26.6± 6.6）min vs.（5.1±1.3） min,（4.6±2.1） min vs.（2.3±1.2） min,（4.9±2.3） min vs.（2.8±1.1）min,（205.5±121.1） minvs.（121.3±89.3） min,respectively,t=22.600,6.724,5.824,3.957,all P〈0.01].The scores of life quality and UCLA function were significantly higher in observation group than in control group after anesthesia （t =16.873,8.485,both P =0.000）.Conclusions The treatment of combined sevoflurane and remifentanil treatment has a good clinical efficacy in elderly patients with shoulder dislocation.It can improve the scores of UCLA and life quality of elderly patients with shoulder dislocation.