靶控输注瑞芬太尼、异丙酚复合局麻在老年患者PPH术中的应用  

The clinical observation of remifentanil combined with propofol administered by TCI during local anesthesia for elderly patients undergoing procedure for prolapse and hemorrhoids

作　　者：纪伟 孔亮 孟秀荣 陈永军 周洪 

机构地区：[1]北京市昌平区中医医院麻醉科 [2]北京市昌平区中医医院普外科,北京102200

出　　处：《结直肠肛门外科》2015年第5期339-342,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的观察靶控输注瑞芬太尼、异丙酚复合局部麻醉应用于老年患者行经吻合器痔上黏膜环切术(PPH)的临床效果。方法 60名行PPH术的老年患者,ASA Ⅰ~Ⅱ级,年龄60~70岁,体重指数18~25 kg/m^2,随机分成A、B两组,每组各30例,A组采用靶控输注瑞芬太尼、异丙酚复合局部麻醉,B组采用腰硬联合麻醉。观察围术期生命体征变化、麻醉效果及术后并发症,对手术时间、麻醉时间、住院时间及住院费用进行比较分析。结果 A组在麻醉后2 min MAP低于基础值(P<0.01),SpO_2低于基础值(P<0.05);两组麻醉效果比较差异无统计学意义(P>0.05);术后尿潴留,A组少于B组(P<0.01);术后眩晕,A组高于B组(P<0.05)。两组麻醉时间比较差异有统计学意义(P<0.01)。A组住院时间较B组短,费用减少。结论靶控输注瑞芬太尼、异丙酚复合局部麻醉应用于老年患者PPH术,术中麻醉效果满意,术后恢复较快,可较早离院,节约医疗费用。Objective To observe the efficacy of remifentanil combined with propofol administered by TCI during local anesthesia for elderly patients undergoing procedure for prolapse and hemorrhoids sugery. Methods Sixty ASA Ⅰ-Ⅱ patients, aged 60 to 70 years, with body mass index 1825kg/m2, were completely randomly divided into two groups（n=30）：group A（the target control infusion of remifentanil and propofol combined with local anesthesia group） and group B（combined spinal epidural anesthesia group）. The changes of vital signs, the effect of anesthesia and postoperative complications were observed, and the operation time, anesthesia time, hospitalization time and hospitalization expenses were compared and analyzed in both groups. Results In group A, MAP at the moment of 2 min after anesthesia was less than the basic value（P〈0.01）, while SpO2 was lower than the basic value（P〈0.05）.There was no significant difference in the anesthesia effects between the two groups（P〉0.05）. The postoperative urinary retention was less in group A than in group B（P〈0.01）, while the postoperative vertigo was higher in group A than in group B（P〈0.05）.There were statistically significant differences in anesthesia time between the two groups（P〈0.01）. The hospitalization time was shorter in group A than in group B, cost was reduced in group A. Conclusions Target controlled infusion of remifentanil combined with propofol plus local anesthesia for elderly patients undergoing procedure for prolapse and hemorrhoids sugery, provide satisfactory anesthesia effect（faster postoperative recovery, earlier from hospital, lower medical expenses）.

关 键 词：靶控输注 瑞芬太尼 丙泊酚 老年患者 麻醉 经吻合器痔上黏膜环切术 

分 类 号：R614.3[医药卫生—麻醉学]