不同吸入麻醉药物对四肢创伤性骨折患者苏醒期躁动的影响

Effects of different inhaled anesthetics on emergence agitation in patients with traumatic limb fractures

目的:比较不同吸入麻醉药物对四肢创伤性骨折患者苏醒期躁动(EA)的影响,为骨科麻醉患者药物的选择提供参考。方法:选择四肢创伤性骨折需切开复位内固定患者102例作为研究对象,采用数字表随机法分为七氟醚组(S组)51例和地氟醚组(D组)51例,比较两组苏醒期躁动发生率、严重程度及麻醉相关不良事件发生情况。结果:D组苏醒时间为(15.84±2.98)min,S组为(19.71±3.75)min,D组苏醒时间短于S组,两组比较差异有统计学意义(P<0.05);麻醉时间、手术时间、拔管时间和舒芬太尼总用量,两组比较差异均无统计学意义(均P>0.05);D组不良反应发生率为23.53%,苏醒躁动率为11.76%,高于S组的11.76%、1.96%,两组比较差异均有统计学意义(均P<0.05);D组拔管时、拔管后10 min Riker镇静躁动(SAS)评分低于S组,RS评分高于S组,两组比较差异均有统计学意义(均P<0.05)。结论:地氟醚吸入麻醉患者术后苏醒时间短于七氟醚吸入麻醉,但患者术后苏醒期躁动发生率及躁动程度均高于七氟醚吸入麻醉,提示使用地氟醚吸入麻醉要注意苏醒期躁动的防治。

Objective:To compare the effects of different inhaled anesthetics on emergence agitation(EA)in patients with traumatic fractures of the limbs,and to provide reference for the selection of drugs for orthopedic anesthesia patients.Methods:A total of 102 patients with traumatic limb fractures requiring open reduction and internal fixation were selected as the research objects.They were randomly divided into sevoflurane group(S group)and desflurane group(D group)with 51 cases in each.The incidence,severity of EA,and the occurrence of adverse events related to anesthesia in the two groups were compared.Results:The wake-up time of group D was(15.84±2.98)min,and the wake-up time of group S was(19.71±3.75)min.The wake-up time of group D was shorter than that of group S(P<0.05).Anesthesia time,operation time,extubation time and total dosage of sufentanil were not significantly different between the two groups(all P>0.05).The incidence of adverse reactions in group D was 23.53%,and the rate of EA was 11.76%,which was higher than those in group S(11.76%and 1.96%),the difference was statistically significant(all P<0.05).The Riker SAS score of group D was lower than that of group S at the time of extubation and 10 minutes after extubation,and the RS score was higher than that of group S(all P<0.05).Conclusion:The postoperative wake-up time of desflurane inhaled anesthesia patients is shorter than that of sevoflurane inhaled anesthesia,but the incidence and degree of EA during the postoperative wake-up period are higher than those of sevoflurane inhaled anesthesia.It is suggested that attention should be paid to the prevention and treatment of EA during the wake-up period when using desflurane inhalation anesthesia.