序贯撤药方法对老年骨科手术患者全麻复苏的影响  

Effect Of Sequential Withdrawal Method For the General Anesthesia Recovery of the Eldly Patients Undergoing Orthopaedic Surgery

作　　者：苏志源[1] 陈裕中[1] 叶青[1] 梁佩雯[1] 

机构地区：[1]广州医科大学附属第三医院,广东广州510150

出　　处：《现代医院》2017年第4期590-593,596,共5页Modern Hospitals

基　　金：广东省医学科学技术研究基金项目(编号:A2015619)

摘　　要：目的探讨序贯撤药方法对老年骨科手术患者全麻复苏的时间、舒适性的影响。方法 65岁以上老年骨科手术患者20例,分为观察组和对照组,每组10例。所有患者采用常规方法行全麻诱导及维持。观察组至术毕前约10min时,停用地氟醚,同时提高瑞芬太尼用量至0.16~0.2μg/kg/min,至术毕停药;对照组持续使用地氟醚及瑞芬太尼至术毕。2组患者均于警觉/镇静评分(OAA/s)4分时拔除气管导管,分别观察其术毕至拔管时间、拔管时的Ricker镇静-躁动评分(SAS)、血流动力学指标、呛咳及呼吸抑制等并发症的发生例数。结果观察组拔管时间显著短于对照组,SAS评分优于对照组,拔管时SBP、DBP、HR均显著低于对照组,观察组呛咳发生例数低于对照组,但2组的呛咳及呼吸抑制发生率无显著性差异。结论序贯撤药方法有利于减少老年骨科手术患者在手术室间的停留时间,并可提高其麻醉复苏的质量及舒适度。Objective Using sequential withdrawal method on the eldly patients with orthopaedic surgery, and to evaluate the effect in the recovery duration of general anesthesia. Methods 20 eldly patients undergoing orthopaedic surgery were divided into 2 groups, Study group and Control group （n = 10）. Routine methods were used for general anesthesia in- duction and maintenance. At about 10min before the end of operation, Desflurane was withdrawal in Study group, and the dose of Remifentanil was increased to 0. 16 - 0. 2 ~g/kg/min till the operation finished. While the dose of desflurane and remifentanil did not change in Control group. All patients removed the endotracheal tube at OAA/s score 4. The duration from the end of operation to endotracheal tube removed, the sedative -agitation score （SAS）, and the hemodynamic indexes and the number of complication were recorded. Results The duration from the end of operation to the endotracheal tube re- moved in Study group was significantly shorter than Control group, and the SAS and the hemodynamic indexes in Study group was significantly better than Control group when removing the endotracheal tube. The frequency of bucking in Study group was lower than Control group, but there was no significant different between two groups. Conclusion Sequential withdrawal method is helpful to reduce the residence time of elderly orthopaedic surgery patients in the operating room, and can improve the quality and comfort of the general anesthesia recovery.

关 键 词：老年病人 骨科手术 地氟醚 瑞芬太尼 

分 类 号：R816.8[医药卫生—放射医学]