舒芬太尼超前镇痛对股骨颈骨折患者血流动力学的影响

HEMODYNAMIC EFFECTS OF SUFENTANIL PREEMPTIVE ANALGESIA IN ELDERLY PATIENTS WITH FEMORAL NECK FRACTURES

目的 研究舒芬太尼超前镇痛对股骨颈骨折患者血流动力学的影响。方法 选择2013年1月~2014年9月ASAⅠ~Ⅲ级股骨颈骨折择期行人工关节置换术患者60例,每组30例,年龄65~91岁,剔除高血压病史者和术前使用降压药治疗者;随机分为A、B两组：A组不用术前药,麻醉医师在患者搬动入手术室前10 min缓慢静注舒芬太尼5 ug,备简易呼吸器,便携式脉搏血氧仪,全程观察陪同患者平卧车入手术室;另一组患者为对照组,术前30 min肌注鲁米那钠0.1 g,由麻醉医师和手术室护士将患者平卧车入手术室。两组患者入室后常规监测心电图（ECG）、血压（BP）、心率（HR）、血氧饱和度（SPO2）,选用腰硬联合麻醉,术后接硬膜外镇痛泵。记录患者搬动前、入室、手术开始、手术结束、术后6 h、12 h、24 h各时间点后10min测血压和心率三次的平均值,并计算心率收缩压乘积。结果 A组患者除搬动前外各时间点血压均低于B组（P〈0.05）,心肌耗氧低,血流动力学比B组更稳定,两组均未出现呼吸抑制现象。结论 舒芬太尼病区超前镇痛,有效减轻股骨颈骨折患者术前搬动引起疼痛致血压升高、心率增快,术中、术后血流动力学更平稳。

Objective To investigate the preemptive analgesia sufentanil in hemodynamic effects of elderly patients with femoral neck fractures. Method Sixty patients with ASA Ⅰ-Ⅲ femoral neck fractures that were scheduled for artificial joint replacement. Each group of 30 examples whose age were 65 -91 years old without hypertension and antihypertensive drug used before surgery. They were in that hospital from January 2013 to September 2014. Randomly selected and divided into A and B group： A group without preoperative medication, the anesthesiologist gave the slow intravenous of sufentanil 5 ug when the patients were moved into surgery before 10 minutes. It needed to prepare bag respirator and portable pulse oximeter. We could observe and accompany the whole course after the patients laid on surgical car then got into the operating room. The intramuscular injection of 0. 1 g luminal sodium before 30 min preoperative medication, the patients of another control group were laid on surgical car and send into surgery by anesthetist and nurse. It should be monitor ECG, BP, HR and SPO2 after the two groups of patients were send into the surgery. The patients used to combine spinal - epidural anesthesia and epidural analgesia after operation. Their blood pressure and heart rate, before the operation began, moved, burglary, end of operation, postoperative 6 h, 12 h, 24 h, after 10 minutes to measure blood pressure and heart rate of three times the average value in each time point, needed to record and calculate the rate of pressure product. Result The time except for before moving, blood pressure and myocardial oxygen consumption of a group was lower than B group （ P 〈 0. 05 ）. The hemodynamies of A group was more stable than B group Respiratory inhibition phenomenon had not founded in two groups. Conclusion Preemptive analgesia with sufentanil ward which can effectively reduced the femoral neck pa- tients before moving to cause pain caused by elevated blood pressure and increased the heart rate, also can make the hemodynamies more stable intraoperative and postoperative.