监护麻醉下联合应用右美托咪定和舒芬太尼对慢性硬膜下血肿钻孔引流术患者麻醉效果的影响

发布时间：2018-07-16 21:38

【摘要】：目的:探讨联合应用右美托咪定和舒芬太尼对慢性硬膜下血肿钻孔引流术患者麻醉效果的影响。方法:96例慢性硬膜下血肿行钻孔引流术患者随机均分为D组和DS组(每组均为48例)。当2组患者的Ramsay镇静评分(RSS)达到3分时,于钻孔处行局部浸润麻醉。分别记录2组患者的麻醉起效时间、术中血流动力学变化、需要实施补救药物的人数、初次使用补救药物的时间、术中患者体动次数、术后恢复时间、患者和外科医师的满意度、药物相关不良反应。结果:与D组相比,DS组患者麻醉起效时间明显降低(13.68±3.13 vs.11.82±2.43 min,P=0.002)。D组患者需要更多咪达唑仑来达到术前设定的镇静标准(31.25%15/48 vs.12.50%6/48,P=0.023),与D组相比,DS组患者需要芬太尼补救者(10.42%5/48 vs.27.08%13/48,P=0.036)和总需要量(89.48±23.27 vs.125.28±33.52μg,P=0.000)明显减低,芬太尼初次使用时间(18.34±4.45 vs.14.34±3.63 min,P=0.000)明显延长。与此同时,D组患者体动次数明显多于DS组(35.42%17/48 vs.16.67%8/48,P=0.036),术后恢复时间明显长于DS组(17.54±5.92 vs.12.57±5.28 min,P=0.000),且患者和外科医师的满意度评分明显低于DS组(P0.05)。D组患者术中心动过缓(37.50%18/48 vs.18.75%9/48,P=0.041)和低血压(37.50%18/48 vs.14.58%79/48,P=0.011)的发生率较DS组高。结论:对于监护麻醉下行慢性硬膜下血肿钻孔引流术患者,联合应用右美托咪定和舒芬太尼较单纯右美托咪定可以减少术中患者体动和药物补救措施及相关不良反应,可以安全有效的应用于临床。
[Abstract]:Objective: to investigate the effect of dexmetidine and sufentanil on the anesthesia of patients with chronic subdural hematoma. Methods 96 patients with chronic subdural hematoma were randomly divided into group D and group DS (48 cases in each group). When the Ramsay sedation score (RSS) of the two groups was 3, local infiltration anesthesia was performed at the borehole. The onset time of anesthesia, hemodynamic changes during operation, the number of patients in need of remedial drugs, the time of initial use of remedial drugs, the times of body movement during operation and the time of recovery after operation were recorded in the two groups. Patient and surgeon satisfaction, drug-related adverse reactions. Results: the onset time of anesthesia in DS group was significantly lower than that in D group (13.68 卤3.13 卤2.43 min P0.002). The patients in group D needed more midazolam to meet the preoperative sedative standard (31.25% 48 vs.12.506% 48% P0.023). Compared with group D, patients in DS group needed fentanyl rescuers (10.422 vs.27.08 / r -48 vs.27.08 / P 0.036) and group D needed fentanyl (10.42 / 548 vs.27.08 / r 48P 0.036) and needed more midazolam in group D than in group D (31.25% 48 vs 12.506% P 0.023). The total requirement (89.48 卤23.27 vs.125.28 卤33.52 渭 g P0. 000) was significantly decreased. The initial use time of fentanyl (18.34 卤4.45 vs.14.34 卤3.63 min P0. 000) was significantly prolonged. At the same time, the number of body movements in group D was significantly higher than that in group DS (35.42 / 48 vs.16.678 / 48 / P0.036), and the postoperative recovery time was significantly longer than that in group DS (17.54 卤5.92 卤5.28 vs.12.57 卤0.000), and the satisfaction scores of patients and surgeons were significantly lower than those in group DS (P0.05) .D (37.50% 48 vs.18.759% P 0.041) and hypoglycemia (P 0.041). The incidence of pressure (37.50 / 48 vs.14.58 yr / 48 P 0.011) was higher than that in DS group. Conclusion: combined use of dexmetidine and sufentanil in patients with chronic subdural hematoma drilling and drainage under monitoring anesthesia can reduce body movement and drug remedy and related adverse reactions. It can be used in clinic safely and effectively.
【作者单位】：鄂尔多斯市中心医院;聊城市人民医院;
【分类号】：R614

【参考文献】