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  

Effect of Different Concentrations of Remifentanil by Target Controlled Infusion to Prevent Tourniquet Pain of Finger Replantation Under Brachial Plexus Anesthesia

作　　者：曹飞[1] 孙晓峰[1] 赵宏[1] 

机构地区：[1]沈阳医学院附属中心医院麻醉科,辽宁沈阳110024

出　　处：《航空航天医学杂志》2015年第10期1186-1188,共3页Journal of Aerospace medicine

摘　　要：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/m L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Sp O2;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4 ng/m L、6 ng/m L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/m L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。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）. Patients in group R1,R2,R3 groups were seperately infused 2,4,6 ng / m L remifentanil continuously at 5 minutes before brachial plexus anesthesia. Control group（ group C） was infused with same amount of saline. MAP,HR and Sp O2 were recorded at following time： before the brachial plexus（ T0） 、skin incision（ T1） 、30 minutes after surgery begin（ T2） 、60minutes after surgery begin（ T3）. Ramsay sedation score,VAS score,the time of the finger replantation and other vascular crisis during surgery were also recorded. Results compared with control group,MAP,HR and VAS score in R1、R2、R3showed 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 / m L 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 / m L of remifentanil are obvious,which should lead to much clinical attention.

关 键 词：瑞芬太尼 TCI 臂丛 断指再植术 止血带痛 

分 类 号：R614[医药卫生—麻醉学]