小剂量瑞芬太尼复合右美托咪定在断指再植术中的麻醉效果及安全性探讨

Anesthetic Effect and Safety of Small Dose Remifentanil Combined with Dexmedetomidine in Replantation of Severed Fingers

目的:研究分析小剂量瑞芬太尼复合右美托咪定在断指再植术中的麻醉效果及安全性。方法:选取笔者医院收治的78例行断指再植术的患者随机分为常规组和小剂量组,各组39例。所有患者均进行肌间沟臂丛神经阻滞,常规组给予常规剂量瑞芬太尼复合右美托咪定麻醉,小剂量组给予小剂量瑞芬太尼复合右美托咪定麻醉。对比两组患者麻醉即刻(T_(0))、术中30min(T_(1))、术中2h(T_(2))及术毕(T_(3))的平均动脉压、心率、呼吸频率;对比两组患者麻醉效果;对比两组患者T_(1)、T_(2)、T_(3)时刻点的Ramsay镇静评分、疼痛视觉模拟评分法(VAS)评分;对比两组患者麻醉药物相关不良应发生情况。结果:两组平均动脉压、心率及呼吸频率均呈现先下降后升高的趋势,差异有统计学意义(P<0.05);小剂量组患者T_(3)时刻点平均动脉压、心率和呼吸频率均高于常规组,差异有统计学意义(P<0.05);而其他时刻点两组患者平均动脉压、心率和呼吸频率比较差异无统计学意义(P>0.05)。两组麻醉效果分级比较差异无统计学意义(P>0.05)。两组患者麻醉后Ramsay镇静评分均随手术时间延长而降低(P<0.05),除T_(3)时刻点小剂量组患者Ramsay镇静评分低于常规组(P<0.05),其他时刻点比较差异无统计学意义(P>0.05)。两组患者VAS镇痛评分均随手术时间延长而增加(P<0.05),两组患者同时刻点VAS镇痛评分比较差异无统计学意义(P>0.05)。小剂量组不良发应总发生率稍低于常规组,但组间比较差异无统计学意义(P>0.05),所有不良反应均在麻醉药物停用及手术结束后得到缓解。结论:小剂量瑞芬太尼复合右美托咪定在断指再植术中具有良好的麻醉效果,安全可靠,值得临床推广应用。

Objective To study the anesthesia effect and safety of small dose remifentanil combined with dexmedetomidine in the digital replantation.Methods 78 cases of replantation were randomly divided into the routine group and the small dose group,39 cases in each group.All patients were performed intermuscular groove brachial plexus block.The routine group was given remifentanil combined with dexmedetomidine anesthesia,and the small dose group was given remifentanil combined with dexmedetomidine anesthesia.The mean arterial pressure,heart rate and respiratory rate were compared between the two groups at the time of anesthesia(T_(0)),30 minutes during operation(T_(1)),2 hours during operation(T_(2))and at the end of operation(T_(3)).The anesthesia effect of the two groups was compared.Ramsay Sedation scores and VAS scores were compared at T_(1),T_(2) and T_(3) in the two groups.The incidence of adverse drug-related reactions was compared between the two groups.Results The mean arterial pressure,heart rate and respiratory rate of the two groups decreased first and then increased,the differences were statistically significant(P<0.05).The mean arterial pressure,heart rate and respiratory frequency of the patients for T_(3) in the low dose group were higher than those in the routine group(P<0.05),but there were no significant difference in mean arterial pressure,heart rate and respiratory rate between the two groups at other times(P>0.05).There were no significant difference in anesthetic effect between the two groups(P>0.05).Ramsay Sedation score of the two groups decreased with the prolongation of operation time(P<0.05).The Ramsay Sedation score in the small dose group was lower than that in the routine group at T_(3)(P<0.05).There were no statistical difference in those between other time points(P>0.05).The VAS scores of the two groups increased with the operation time(P<0.05),but there were no significant difference between the two groups(P>0.05).The incidence of adverse reactions in the small dose group was slightly lower than that in the routine group(P>0.05),and all adverse reactions were relieved after the end of anesthesia and operation.Conclusion Small dose remifentanil combined with dexmedetomidine has a good anesthetic effect in the digital replantation,safe and reliable,which is worthy of clinical application.