右美托咪定复合雷米芬太尼全身麻醉在内固定取出术中的应用

Application of general anesthesia with combined use of dexmedetomidine and remifentanil in orthopaedic patients undergoing internal fixation removal

目的观察右美托咪定复合雷米芬太尼全身麻醉(全麻)在内固定取出术中的应用效果。方法骨科内固定取出术患者80例随机均分为两组。均采用雷米芬太尼0.2μg·kg^(-1)·min^(-1)全麻,喉罩通气。试验组麻醉诱导前10min内泵注右美托咪定0.8μg/kg,术中持续泵注右美托咪定0.4μg·kg^(-1)·h^(-1)至术毕;对照组不用右美托咪定。记录患者入室后(T0)、喉罩置入时(T1)、喉罩置入后1min(T2)、切皮后1min(T3)、拔除喉罩后1min(T4)和15min(T5)的HR、MAP和SpO_2,记录拔除喉罩后15min内的躁动发生情况。结果与对照组相比,试验组T2~T5的HR、MAP和拔除喉罩后的躁动评级降低(P<0.05)。两组各时间点SpO_2差异无统计学意义(P>0.05)。结论在骨科内固定取出术中,右美托咪定复合雷米芬太尼全麻患者的血流动力学更稳定,术后苏醒质量提高,不良反应减少。

Objective To observe the efficacy of general anesthesia with combined use of dexmedetomidine and remifentanil in orthopaedic patients undergoing internal fixation removal . Methods The internal fixation removal surgery was performed in 80 patients under general anesthesia with remifentanil 0.2 μg ？ kg‐1 ？ min‐1 and laryngeal mask airway （LMA） ventilation .The patients were equally randomized into two groups .Dexmedetomidine 0.8μg/kg was infused within 10 minutes before anesthesia induction in group A ,which was followed by dexmedetomidine 0.4 μg kg‐1 h‐1 until the end of operation .Dexmedetomidine was not used in group B as the control .The HR ,MAP and SpO2 were recorded at the time points of baseline（T0） ,LMA placement（T1） ,at one minute after LMA insertion（T2） ,one minute after incision（T3） ,one minute（T4） and 15 minutes（T5） after LMA removal .The agitation was observed within 15 minutes after LMA removal .Results The HR and MAP at T2 to T5 and incidence of agitation after LMA removal were less in group A than those in group B （ P〈0 .05 ） .The SpO2 in two groups was in normal limits during surgery （ P〉0 .05 ） . Conclusion Compared to remifentanil alone ,combined use of dexmedetomidine and remifentanil in orthopaedic patients undergoing internal fixation removal is more effective in maintaining circulation stable ,improving the quality of awakening and reducing postoperative adverse effects .