瑞芬太尼与氯胺酮复合异丙酚静脉麻醉用于重睑术中的疗效对比

Effect of Remifentanil and Ketamine Combined with Propofol Intravenous Anesthesia on Double Eyelid Surgery

目的:对比分析瑞芬太尼复合异丙酚和氯胺酮复合异丙酚静脉麻醉在重睑术中的麻醉效果及安全性,为重睑术麻醉方案的选择提供参考。方法:纳入笔者医院2014年1月-2017年12月符合条件的重睑术就医者108例作为研究对象,按照手术顺序编号,采用数字随机表法分为2组,每组54例。瑞芬太尼组采用瑞芬太尼复合异丙酚静脉麻醉,氯胺酮组采用氯胺酮复合异丙酚麻醉,记录两组就医者围手术期氧合状态、通气状况及脑功能指标变化[平均动脉压(MAP)、心率(HR)、呼吸频率(BR)、血氧饱和度(SpO_2)、呼气末二氧化碳分压(PETCO_2)],及围手术期并发症发生情况等。结果:两组患者入室后即刻、局麻后20min MAP、HR、BR、SpO_2、PETCO_2比较差异无统计学意义(P>0.05),但瑞芬太尼组静脉麻醉即刻、局麻即刻、局麻后10min MAP、HR、BR均明显低于氯胺酮组,差异有统计学意义(P<0.05)。瑞芬太尼组Ramsay镇静评分(2~4分)率为88.89%明显高于氯胺酮组的70.37%,差异有统计学意义(P<0.05)。瑞芬太尼组BCS舒适评分为(2.81±0.93)分明显高于氯胺酮组的(2.41±0.72)分,差异有统计学意义(P<0.05)。瑞芬太尼组围手术期并发症发生率为11.11%明显低于氯胺酮组的22.22%,差异有统计学意义(P<0.05)。结论:瑞芬太尼复合异丙酚用于重睑术麻醉综合效果优于氯胺酮复合异丙酚麻醉方案,为手术创造了更优的麻醉效果,具有较高的临床价值。

Objective To compare and analyze the effect and safety of remifentanil and ketamine combined with propofol intravenous anesthesia, and to provide reference for the selection of the anesthesia scheme for the double eyelid operation. Methods 108 cases of double eyelid surgery were included in our hospital from January 2014 to December 2017. According to the number of the operation sequence, the digital random table was used to divide into two groups, with 54 cases in each group. The remifentanil group was treated with remifentanil combined with propofol intravenous anesthesia. The ketamine group was treated with ketamine combined with propofol. The changes of oxygen status, ventilation and brain function [mean arterial pressure（MAP）, heart rate（HR）, respiratory frequency（BR）] were collected in two groups of patients. The blood oxygen saturation（SpO2）, the end expiratory carbon dioxide partial pressure（PETCO2）, and the perioperative complications were evaluated and compared. Results There were no significant differences in MAP, HR, BR, SpO2 and PETCO2 between the two groups immediately after admission and 20 min after local anesthesia（P〉0.05）. The MAP, HR and BR of the remifentanil group were significantly lower than those of the ketamine group immediately after intravenous anesthesia, immediately after local anesthesia and 10 min after local anesthesia（P〈0.05）. The Ramsay sedation score（2-4 points） in the remifentanil group was 88.89%, significantly higher than that in the ketamine group（70.37%, P〈0.05）. The BCS comfort score of the remifentanil group was（2.81±0.93）, which was significantly higher than that of the ketamine group（2.41±0.72, P〈0.05）. The incidence of perioperative complications in remifentanil group was 11.11%, which was significantly lower than that in the ketamine group（22.22%,P〈0.05）. Conclusion The combined effect of remifentanil and propofol in double eyelid anesthesia is better than that of ketamine combined with propofol. It can create better anesthetic effect for the operation, and it has high clinical value.