小剂量丙泊酚复合瑞芬太尼镇痛在下肢骨折手术前麻醉体位摆放中的应用

Small dose of propofol combined with remifentail as preoperative analgesia in femoral fracture patients position alteration during anesthesia

目的：探讨小剂量丙泊酚复合瑞芬太尼镇痛在急诊下肢骨折手术麻醉前体位摆放时的安全性及可行性。方法：选择拟行腰硬联合麻醉下股骨骨折开放复位内固定术患者60例，随机分为小剂量丙泊酚复合瑞芬太尼组（A组）：摆放体位前30S内缓慢静脉推注丙泊酚1mg／kg、瑞芬太尼1ug／kg，然后持续静脉泵注瑞芬太尼0．1μg·kg。·min^-1；对照组（B组）：摆放体位前不给任何镇痛药物，每组30例。记录入室后15min（T1）、摆放体位前（T2）、摆放体位后即刻（T3）及穿刺结束时（T4）MAP、HR、SpO2；每组一次穿刺成功率及体位摆放过程中VAS评分；评估患者满意率。结果：与T1时比较，A组T2～3时MAP、HR均下降（P〈0．05），B组T3～4时MAP、HR均升高（P〈0．05）；与A组比较，B组T3～4时MAP、HR均升高（P〈0．05）；两组各时点SpOz未见明显变化；A组一次穿刺成功率及患者满意率均明显高于B组（P〈0．05），体位摆放过程中VAS评分则明显低于B组（P〈0．05）。结论：小剂量丙泊酚复合瑞芬太尼能有效缓解股骨骨折患者腰硬联合麻醉前体位摆放时的疼痛，提高麻醉穿刺成功率，可安全有效地应用于此类患者。

Objective：To study the safety and feasibility of using small dose of propofol combined with remifen-tail as preoperative analgesia in femoral fracture patients when they are moved during combined spinal and epidural anesthesia. Method： Sixty patients with femoral fracture undergoing open reduction and internal fixation with com-bined spinal and epidural anesthesia were randomly divided into two groups,each of 30 cases. Group small dose of propofol combined with remifentail（Group A） were intravenous injection propofol 1 mg/kg and remifentanil 1 μg/ kg in 30 s,then remifentanil 0.1μg · kg^-1 · min^1 intravenous infusion before combined spinal and epidural anes-thesia. Group control （Group B） were accorded to conventional combined spinal and epidural anesthesia with no an-algesia. Monitor MAP, HR and SpO2 at 15 min after going into the operation room（T1）, before and after lateral position（T2-3） ,and at the end of intraspinal puncture（T4）. One-time success rate of intraspinal puncture in each group and VAS scores during lateral position were recorded. And the satisfaction rate of patients for analgesia were also recorded. Result：Compared with T1, both MAP and HR at T2-3 were significantly lower in group A（P〈0. 05） ,and both of them at T3-4 were significantly higher in group B（P〈0.05）. Both MAP and HR at T3-4 were significantly higher in group B than group A （P〈0.05）. There were no remarkable differences between the two groups with respect to SpO2 of different observing time. Both one-time success rate of intraspinal puncture in each group and the satisfaction rate of patients for analgesia in group A were remarkably higher than in group B. Con- versely,VAS scores during lateral position in group A were remarkably lower than in group B. Conclusion： As a method of preoperative analgesia, small dose of propofol combined with remifentail can effectively alleviate the pain resulted from the moving position when femoral fracture patients are performed combined spinal and epidural anes-thesia,which improved intraspinal anesthesia puncture success rate. And this method may be safely and effectively used in such patients.