瑞芬太尼复合咪达唑仑在肿胀麻醉法脂肪抽吸术中的应用

目的观察瑞芬太尼复合咪达唑仑用于肿胀麻醉法脂肪抽吸术中的镇静镇痛效果。方法选择肿胀麻醉法行腹部脂肪抽吸术的患者30例,ASAⅠ～Ⅱ级。所有患者在肿胀麻醉前5min静脉推注咪达唑仑0.3mg/Kg和瑞芬太尼负荷剂量0.6μg/Kg(推注时间30s),之后静脉泵入瑞芬太尼0.1～0.3μg/Kg·min维持。记录患者在麻醉前(T0)、注射肿胀液前即刻(T1)、注射肿胀液时(T2)、脂肪抽吸时(T3)、手术结束时(T4)、术后30min时(T5)的Ramsay镇静评分和VAS痛觉模拟评分;观察患者在麻醉和手术过程中的血流动力学改变以及不良事件发生情况。结果所有患者在T1至T5时,VAS痛觉模拟评分均小于5分。与T0比较,T1时患者Ramsay镇静评分、心率(HR)、收缩压(SBP)、舒张压(DBP)均升高(P<0.05),呼吸频率(RR)降低(P<0.05);T2至T5时,上述指标无明显改变(P>0.05)。本组中有2例患者出现嗜睡和呼吸抑制(RR<8次/分),血氧饱和度(SpO2)最低降至90%,经指令性通气和减少瑞芬太尼用量后SpO2迅速恢复。结论瑞芬太尼复合咪达唑仑用于肿胀麻醉法脂肪抽吸术,能起到良好的镇静镇痛作用,术后恢复时间短,适合在日间脂肪抽吸术中推广应用。

Effects of Remifentanyl Combined with Midazolam on Sedation and Analgesia in Liposuction under Tumescent Anesthesia

Objective To explore the effects of Remifentanyl combined with Midazolam on sedation and analgesia in liposuction under tumescent anesthesia.Methods Thirty selective patients（ASAⅠ-Ⅱ） were treated by liposuction under tumescent anesthesia.All the patients were given Midazolam 0.3 mg/Kg ＋ Remifentanyl 0.6 μg/Kg·min through venous for 30 seconds as loaded dose before tumescent anesthesia,then Remifentanyl at the rate of 0.1-0.3 μg/Kg·min was infused through venous pump.The Ramsay and VAS for scoring at the point before anesthesia（T0）,the point before given the tumescent fluid（T1）,the point of given the tumescent fluid（T2）,the point of the beginning of liposuction（T3）,the ending point of liposuction（T4）,and 30 minutes after the liposuction（T5） were all recorded.The change of hemodynamic during anesthesia and liposuction as well as incidence were observed and recorded.Results The VAS grades were lower less than 5 in all patients.Compared with T0,the patients＇ Ramsay grades,HR,SBP,DBP were higher（P〈0.05）,RR were lower（P〈0.05）.There was no significant difference at T2-T5（P 〉0.05）.Two patients had the symptom like drowsiness and respiratory depression（RR8 times/min） and SpO2 declined to 90%,while the SpO2 could recover to the normal level by the instruction ventilation and decreasing the volume of Remifentanyl.Conclusion Effective sedation and analgesia can be accomplished by using Remifentanyl combined with Midazolam in liposuction under tumescent anesthesia.The recovering time for recovery could be shortening,so this method can be considered to develop in daytime abdominal liposuction.