摘要
目的 探讨瑞芬太尼复合丙泊酚用于老年患者清醒状态下肩关节脱位手法整复术的可行性，并与臂丛神经阻滞麻醉效果进行比较。方法 2011 年 8 月－ 2013 年 12 月选择美国麻醉医师协会分级Ⅰ - Ⅱ级老年肩关节脱位手法复位患者 70 例，随机分为 2 组，每组各 35 例。A 组以臂丛神经阻滞麻醉方法下行手法复位，B 组采用瑞芬太尼 - 丙泊酚 - 利多卡因复合液缓慢静脉滴注麻醉方法下行手法复位，麻醉成功后，两组患者均采用拔伸足蹬法进行复位。观察两组患者复位过程中两种麻醉方法麻醉效果、血流动力学变化、复位时间、离室时间、术后满意度、术中记忆情况、呼吸遗忘（呼吸间隔＞ 15 s）以及视觉模拟评分（VAS），并进行组间比较。结果 两组患者均能顺利完成手法复位，与 A 组患者比较，B 组患者复位过程中血流动力学更加稳定，复位过程所需时间更短，麻醉效果及术后满意度均明显优于 A 组差异有统计学意义（P ＜ 0.05），A、B 两组患者离室时间相比较，差异无统计学意义（P ＞ 0.05）。A 组患者 VAS 评分高于 B 组患者（P ＜ 0.05）。B 组部分患者术后存在术中记忆遗忘以及呼吸遗忘的现象发生，A 组患者无记忆遗忘以及呼吸遗忘现象发生。结论 瑞芬太尼 - 丙泊酚 - 利多卡因复合液能够安全用于老年患者清醒状态下实施肩关节脱位手法整复术，具有安全性高、起效迅速、镇痛完全、血流动力学稳定等优点，具有临床推广价值。
Objective To study the feasibility of using propofol and remifentanil for reduction of shoulder joint dislocation in the conscious elderly patients,and compare its efficacy with brachial plexus block anesthesia.Methods Seventy elderly patients（American Sociaty of Anesthesiologist physical status Ⅰ-Ⅱ） who underwent shoulder dislocation reduction in our hospital between August 2011 and December 2013 were randomly divided into two groups,each group having 35 cases.Patients in group A received brachial plexus nerve block anesthesia downlink gimmick reset,while patients in group B received the use of remifentanil-propofol and lidocaine compound liquid intravenous drop infusion for anesthesia downlink manipulative reduction.After successful anesthesia,two groups of patients were treated with traction and foot pedal method（Hippocrates） to reset.We observed the two groups of patients in the process of reduction,and recorded their hemodynamic changes,reset time,discharge time,postoperative satisfaction,intra-operative memory,breathing forgotten（breathing interval was longer than 15 seconds） and visual analogue scale（VAS） scores,and then comparison was made between the two groups.Results Patients in both the two groups successfully completed manipulative reduction.Compared with group A,patients in group B had more stable hemodynamic indexes during the process of reduction,shorter reduction time,better anesthesia effect and higher postoperative satisfaction degree,and the differences were statistically significant（P〈0.05）.There was no significant difference in terms of time of leaving the operation room between the two groups（P〉0.05）.VAS score was higher in group A than that in group B（P〈0.05）.The occurrence of intra-operative memory amnesia and breathing forgotten phenomenon existed in part of the patients after operation in group B,but they did not occur in patients in group A.Conclusion Remifentanyl propofol-lidocaine compound fluid can be safely used in conscious elderly patients fo
出处
《华西医学》
CAS
2015年第4期673-676,共4页
West China Medical Journal
关键词
瑞芬太尼
丙泊酚
手法复位
清醒
臂丛
老年
Remifentanyl
Propofol
Manipulative reduction
Conscious
Brachial plexus
Old age
