地佐辛复合七氟醚麻醉在老年股骨近端防旋髓内钉手术中的应用

Application of Dezocine combined with Sevoflurane for anesthesia in elderly patients of PFNA operations

目的探讨地佐辛复合七氟醚麻醉维持用于老年股骨近端防旋髓内钉（proximal femoral nailantirotation,PFNA）手术的临床效果。方法选取麻醉分级Ⅰ、Ⅱ级骨科PFNA手术患者80例,年龄60-75岁,随机分两组,每组40例。观察组（A组）采用地佐辛复合七氟醚全身麻醉（全麻）术中维持;对照组（B组）瑞芬太尼复合七氟醚全麻术中维持。观察两组围术期血流动力学参数,苏醒、拔管时间,拔管后镇静评分及围术期不良反应。结果两组拔管时间、拔管后1 h镇静评分差异有统计学意义（P〈0.05）。A组患者围术期心率（HR）及血压（BP）无明显变化（P〉0.05）;B组患者手术开始30 min的心率较术前明显下降（P〈0.05）,术中血压明显低于麻醉前（P〈0.05）,术毕2 h的血压明显增高（P〈0.05）且与A组比较组间差异有统计学意义（P〈0.05）。A组围术期心动过缓、低血压及苏醒期躁动发生率明显低于B组（P〈0.05）,两组患者围术期心动过速、高血压、术后24h术后恶心呕吐（PONV）发生率差异无统计学意义（P〉0.05）。结论地佐辛复合七氟醚麻醉维持的术毕苏醒质量好,围术期血流动力学平稳,不良反应少适用于老年PFNA手术。

[Objective] To investigate the application of Dezocine combined with Sevoflurane for maintain anesthesia in elderly patients of proximal femoral nailantirotation （PFNA）. [Methods ] Eighty ASA Ⅰ or Ⅱ patients for PFNA Operations, aged 60 - 75 years, were divided into two groups randomly （n =40）. In control group （group A）, the anesthesia was maintained with Dezocine combined with Sevoflurane; in experimental group （group B）, the anesthesia was maintained with Remifentanil and Sevoflurane. The perioperative hemodynamic parameters, recovery time, extubation time, sedation scores after extubation （OAAS） and incidence of side effects were observed. [Results] There were significantly different in extubation time and sedation scores after extubation in the two groups. In the group A, the heart rate and blood pressure were no changes during perioperation （P〈0.05）. In the group B, compared to the base line, the heart rate increased after operation 30 minutes, blood pressure during the operation reduced. Blood pressure of 2 hours after operation increased in group B, and was different in two groups （P〈0.05）. In A group, incidence of hypertension, bradycardia or emergency agitation was lower than group B, similar incidence of perioperative polycardia, hypertension and POVN in two groups （P〉0.05）. [Conclusions] Dezocine combined with Sevoflurane for maintain anesthesia with better recovery profile, more stable hemodynamics and lower incidence of side effects, suitable for the elderly patients of PFNA Operations.