航空航天医学杂志
航空航天醫學雜誌
항공항천의학잡지
Journal of Aerospace Medicine
2015年
10期
1186-1188
,共3页
瑞芬太尼%TCI%臂丛%断指再植术%止血带痛
瑞芬太尼%TCI%臂叢%斷指再植術%止血帶痛
서분태니%TCI%비총%단지재식술%지혈대통
Remifentanil%target controlled infusion%brachial plexus%finger replantation%tourniquet pain
目的 评价不同靶控浓度瑞芬太尼防治臂丛神经阻滞麻醉下断指再植手术止血带痛的效果. 方法 急诊拟行断指再植手术患者80例,ASAⅠ或Ⅱ级,随机分为4组,每组20例(n=20):实验组:R1、R2、R3 组于麻醉前5 min开始持续输注血浆靶浓度分别为2、4、6 ng/mL的瑞芬太尼;对照组:C组输入等量生理盐水. 分别于麻醉开始前(T0)、切皮(T1)、手术开始30 min(T2)、60 min(T3)各时间点观察平均动脉压(MAP)、心率(HR)和SpO2;Ramsay镇静评分、VAS评分、单指再植所用手术时间、术中血管危象发生等情况. 结果 与对照组比较, R1、R2、R3 各组MAP、HR、VAS评分呈剂量依赖性降低;瑞芬太尼浓度增大Ramsay镇静评分升高、术中止血带痛、血管危象发生率逐渐降低. 结论 瑞芬太尼靶控血浆浓度4ng /mL、6 ng/mL均可以有效预防臂丛神经阻滞麻醉下断指再植手术止血带痛的发生,靶控血浆浓度6 ng/mL的瑞芬太尼引起低的氧血症、心率降低、嗜睡等副作用明显,应该引起临床高度重视.
目的 評價不同靶控濃度瑞芬太尼防治臂叢神經阻滯痳醉下斷指再植手術止血帶痛的效果. 方法 急診擬行斷指再植手術患者80例,ASAⅠ或Ⅱ級,隨機分為4組,每組20例(n=20):實驗組:R1、R2、R3 組于痳醉前5 min開始持續輸註血漿靶濃度分彆為2、4、6 ng/mL的瑞芬太尼;對照組:C組輸入等量生理鹽水. 分彆于痳醉開始前(T0)、切皮(T1)、手術開始30 min(T2)、60 min(T3)各時間點觀察平均動脈壓(MAP)、心率(HR)和SpO2;Ramsay鎮靜評分、VAS評分、單指再植所用手術時間、術中血管危象髮生等情況. 結果 與對照組比較, R1、R2、R3 各組MAP、HR、VAS評分呈劑量依賴性降低;瑞芬太尼濃度增大Ramsay鎮靜評分升高、術中止血帶痛、血管危象髮生率逐漸降低. 結論 瑞芬太尼靶控血漿濃度4ng /mL、6 ng/mL均可以有效預防臂叢神經阻滯痳醉下斷指再植手術止血帶痛的髮生,靶控血漿濃度6 ng/mL的瑞芬太尼引起低的氧血癥、心率降低、嗜睡等副作用明顯,應該引起臨床高度重視.
목적 평개불동파공농도서분태니방치비총신경조체마취하단지재식수술지혈대통적효과. 방법 급진의행단지재식수술환자80례,ASAⅠ혹Ⅱ급,수궤분위4조,매조20례(n=20):실험조:R1、R2、R3 조우마취전5 min개시지속수주혈장파농도분별위2、4、6 ng/mL적서분태니;대조조:C조수입등량생리염수. 분별우마취개시전(T0)、절피(T1)、수술개시30 min(T2)、60 min(T3)각시간점관찰평균동맥압(MAP)、심솔(HR)화SpO2;Ramsay진정평분、VAS평분、단지재식소용수술시간、술중혈관위상발생등정황. 결과 여대조조비교, R1、R2、R3 각조MAP、HR、VAS평분정제량의뢰성강저;서분태니농도증대Ramsay진정평분승고、술중지혈대통、혈관위상발생솔축점강저. 결론 서분태니파공혈장농도4ng /mL、6 ng/mL균가이유효예방비총신경조체마취하단지재식수술지혈대통적발생,파공혈장농도6 ng/mL적서분태니인기저적양혈증、심솔강저、기수등부작용명현,응해인기림상고도중시.
Objective To evaluate the effect of different concentrations of remifentanil by target controlled infusion ( TCI) to prevent tourniquet pain of finger replantation under brachial plexus anesthesia.Methods Eighty patients (ASA I -II) of emergency surgery of finger replantation were randomly divided into four groups (n=20 each).Pa-tients in group R1 ,R2 ,R3 groups were seperately infused 2, 4, 6 ng/mL remifentanil continuously at 5 minutes before brachial plexus anesthesia .Control group ( group C) was infused with same amount of saline.MAP,HR and SpO2 were recorded at following time:before the brachial plexus ( T0 )、skin incision (T 1 )、30 minutes after surgery begin ( T2 )、60 minutes after surgery begin (T3).Ramsay sedation score, VAS score, the time of the finger replantation and other vascu-lar crisis during surgery were also recorded.Resulst compared with control group, MAP, HR and VAS score in R1、R2、R3 showed a dose-dependent reduction; Ramsay sedation score increased, and intraoperative tourniquet pain and the incidence of vascular crisis gradually decreased by increasing concentration of remifentanil.Conclusions 4 ng/mL of plasma concentration of remifentanil can be effective in preventing the tourniquet pain of finger replantation under the brachial plexus anesthesia .Hypoxemia、dereased heart rate、drowsiness and other side effects caused by target controlled plasma concentration of 6 ng/mL of remifentanil are obvious, which should lead to much clinical attention.
