盐酸右美托咪定联合瑞芬太尼在骨科手术中的麻醉效果

Anesthetic Effect of Dexmedetomidine Hydrochloride Combined with Remifentanil in Orthopedic Surgeries

目的:分析在骨科手术中盐酸右美托咪定联合瑞芬太尼麻醉的效果及对血气指标、不良反应的影响。方法:选择2015年5月—2017年5月在我院接受骨科手术治疗的128例患者为研究对象,按麻醉用药的不同分为对照组与观察组,各64例。对照组使用瑞芬太尼[术前5 min,0.8μg/kg,iv,之后以0.1μg/(kg·min)维持]联合丙泊酚[术前5 min,2 mg/kg,iv,之后以4μg/(kg·h)维持]麻醉,观察组使用盐酸右美托咪定[术前10 min,1μg/kg,iv,之后以0.3μg/(kg·h)维持]联合瑞芬太尼[术前10 min,0.8μg/kg,iv,之后以0.1μg/(kg·min)维持]麻醉,比较两组麻醉效果、血气指标[呼吸频率(RR)、心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2)]及不良反应发生情况。结果:与对照组比较,观察组麻醉时间与拔管时间均少于对照组(P<0.05),观察组术后Ramsay镇静评分(RSS)、视觉模拟疼痛评分(VAS)均优于对照组(P<0.05);观察组10 min(T1)、20 min(T2)、30 min(T3)时的RR、Sp O2水平均高于对照组(P<0.05);观察组麻醉期间呼吸抑制率、呼吸道梗阻率、恶心呕吐率均低于对照组(P<0.05)。结论:骨科手术中应用盐酸右美托咪定联合瑞芬太尼的麻醉效果显著,安全性高,值得推广。

Objective: To analyze the anesthetic effect of dexmedetomidine hydrochloride combined with remifentanil in orthopedic surgeries and effect on blood gas indexes and adverse reactions. Methods: 128 patients who received orthopedic surgeries in our hospital between May 2015 and May 2017 were selected as subjects and divided into control group and observation according to different anesthetic medications, 64 cases in each group. The patients in the control group were given remifentanil [5 min before surgery, 0.8 μg/kg, iv, then 0.1 μg/(min·kg) for maintenance] and propofol [5 min before surgery, 2 mg/kg, iv, then 4 μg/(kg·h) for maintenance] for anesthesia, and the patients in the observation group was given dexmedetomidine hydrochloride [10 min before surgery, 1 μg/kg, iv, then 0.3 μg/(kg·h) for maintenance] and remifentanil [10 min before surgery, 0.8 μg/kg, iv, then 0.1 μg/(kg·min) for maintenance] for anesthesia. The anesthetic effects, blood gas indexes [respiratory rate(RR), heart rate(HR), mean arterial pressure(MAP) and blood oxygen saturation(Sp O2)] and adverse reactions were compared between the two groups. Results:Both time for anesthesia and time for extubation in the observation group were shorter than those in the control group(P<0.05), and the Ramsay sedation score(RSS) and visual analogue pain score(VAS) in the observation group were better than those in the control group(P<0.05); the levels of RR and Sp O2 at 10 min(T1), 20 min(T2) and 30 min(T3) in the observation group were higher than those in the control group(P<0.05); the respiratory depression rate, airway obstruction rate and nausea and vomiting rate during anesthesia in the observation group were lower than those in the control group(P<0.05). Conclusion: Dexmedetomidine hydrochloride combined with remifentanil used in orthopedic surgeries is of significant anesthetic effect and high safety, and is worthy of promotion.