瑞芬太尼在颈椎手术中清醒镇静的临床研究

目的评价瑞芬太尼用于颈丛阻滞下颈椎前入路手术清醒镇静镇痛的有效性和安全性。方法选择拟行颈椎前入路手术患者40例，年龄45～59岁，ASAⅠ～Ⅱ级，随机分为瑞芬太尼组（R组）和对照组（C组）（每组20例），颈丛神经阻滞后，R组手术开始前5min给予6μg·kg^-1·h^-1瑞·芬太尼连续榆注，根据OAA／S评分调整输注速度，直至镇静为OAA／S=3分。C组给予哌替啶50mg氟哌利多2．5mg，比较两组颈丛阻滞前（T0）、手术开始后5min（T1）、手术开始后30min（T2）、间盘切除时（T3）、手术结束时（T4）各点MAP，HR，SpO2，自主呼吸频率（sRR）的变化。用视觉模拟评分法VAS评定患者对镇痛的满意程度，观察呼吸抑制、肌肉僵硬、恶心呕吐、皮肤瘙痒等不良反应。结果R组MAP于T2，T3，T4，HR于T1，T2，T3，T4，sRR于T2，T3，SpO2于T3较T0相比差异有显著性，但其数值均在生理范围之内。R组对镇静镇痛满意度的VAS评分为92，而C组为45，两组差异有显著性。结论小剂量瑞芬太尼辅助颈丛阻滞用于颈椎前入路手术安全有效，患者对镇静镇痛满意度高，且无明显副作用。

Clinical Use of Remifentanil for Conscious Sedation during Resection of Cervical Vertebrae Disc under Cervical Plexus Blockade

Objective To evaluate the efficacy and safety of remifentanil for conscious sedation （luring resection of cervical vertebrae disc under cervical plexus blockade. Methods After informed consent was given,40 ASA Ⅰ-Ⅱ patients undergoing resection of cervical vertebrae disc under cervical plexus blockade were randomly individed into two groups with 20 patients in each ： control group （ group C ） and Remifentanil group（ group R）. The patients received continous intraveous infusion without loading dose remifentanil 6μg·kg^-1·h^-1（ Group R） or pethidine hydrochloride 50mg and droperidol 2.5mg （ group C） at 5min before operation. Depth of sedation was maintained at the Obseverg Assessment of Ahertness/Sedation Scale （OAA/S） = 3 by adjusting the rate of remifentanil. Haemodynamic variation, the value of SpO2 , spontaneous Respiration Rate （sRR） were recorded. The incidence of hypotension, bradycardia, nausea, pruritus, sweating were recorded daring sedation. The scores of satisfaction was measured with a visual analog scale. Results There was no significant difference in age,body weight,duration of operation. MAP were significantly changed at T2,T3 ,T4 in R groups（ P 〈 0.05） , HR were significantly changed at T1,T2, T3 ,T4 in R groups（ P 〈0.05） SpO2 was decreased in R group at T3 as compared with T0（P 〈0.05）. sRR was significantly decreased at T2, T3 as compared with To in group R（ P 〈 0.05 ）. But there were in the normal range. There was no significant difference in the incidence of the side effects in two groups,The scores of patients satisfaction was higher in R group than in C group. Conclusion Remifentanil can provide haemodynamic ,respiration stability,and the higher scores of patients satisfaction with a low risk of side effects in conscious sedation during resection of cervical vertebrae disc under cervical plexus blockade.