王利敏,刘新生
WANG Limin,LIU Xinsheng

• 1:河南省郑州市骨科医院药学部
• 2:濮阳市人民医院麻醉科

摘要(Abstract)：

目的探讨不同浓度瑞芬太尼靶控输注用于老年股骨转子间骨折全麻术对苏醒质量及拔管反应的影响。方法选取某院收治的老年股骨转子间骨折患者98例,按数字表法随机分为高浓度组和低浓度组,每组49例,均使用气管插管全身麻醉。在手术结束前15 min停止使用丙泊酚,低浓度组患者将瑞芬太尼靶控浓度调至为1.5μg·mL~(-1),高浓度组将瑞芬太尼靶控浓度调至为2.0μg·mL~(-1)。各组患者达到拔管指征后拔管。观察两组患者拔管期间血压、心率变化及拔管反应等发生情况。结果与T1比较,两组在T2、T3、T4时DBP、SBP、HR均明显下降,差异有统计学意义(P<0.05);高浓度组与低浓度组比较,T2、T3、T4时DBP、SBP均明显下降,差异有统计学意义(P<0.05);两组各时间点心率(HR)比较,差异无统计学意义(P>0.05);两组苏醒评分、苏醒时间、拔管时间差异无统计学意义(P>0.05);高浓度组咽痛评分、呛咳评分、拔管记忆情况均明显优于低浓度组(P<0.05)。结论股骨转子骨折全麻手术中,在停用丙泊酚后给予浓度为2.0 ng·mL~(-1)的瑞芬太尼靶控输注,能明显减少拔管反应的发生,且不影响拔管时间及苏醒质量。
OBJECTIVE To investigate the effect of remifentanil target controlled infusion with different concentrations of recovery quality and extubation reaction on the management of intertrochanteric fracture in elderly patients.METHODS 98 cases of intertrochanteric fracture were treated in a hospital,they were randomly divided into high concentration group and low concentration group by digital meter method,there were 49 cases in each group.Two groups of patients were treated by general anesthesia with endotracheal intubation.Propofol was discontinued at the end of the operation at 15 min,the target concentration of remifentanil was adjusted to 1.5 μg·mL-1in low concentration group,the target concentration of remifentanil was adjusted to 2.0 μg·mL~(-1) in high concentration group.After reaching the indication of extubation pulled out the tube.The changes of blood pressure,heart rate and extubation reaction were observed during extubation in the two groups.RESULTS Compared with T1,the DBP,SBP and HR of the two groups decreased significantly at T2、T3 and T4,the difference was statistically significant(P<0.05).High concentration group compared with low concentration group,at T2、T3 and T4,DBP and SBP decreased significantly,the difference was statistically significant(P<0.05),the two group at different time points were compared to HR,the difference was not statistically significant(P>0.05),there was no significant difference in recovery score,recovery time and extubation time between the two groups(P>0.05).high concentration group angina score,cough score,extubation and memory were significantly better than low concentration group(P<0.05).CONCLUSION During the operation of general anesthesia for intertrochanteric fracture,after stopping propofol,remifentanil target controlled infusion with a concentration of 2.0 ng·mL~(-1) is given,it can obviously reduce the occurrence of extubation reaction,the extubation time and recovery quality are not affected.

关键词(KeyWords)： 瑞芬太尼;股骨转子间骨折;苏醒质量;拔管反应
remifentanil;intertrochanteric fracture;recovery quality;extubation reaction

Abstract:

Keywords:

基金项目(Foundation): 河南省科学技术厅项目(9412017Y0626)

作者(Author): 王利敏,刘新生
WANG Limin,LIU Xinsheng

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