清醒镇痛术在门急诊患者局麻手术中的应用

目的观察瑞芬太尼和芬太尼作为清醒镇痛药物在门诊急诊局麻手术中应用的临床效果。方法将符合入选标准和排除标准、需麻醉医生补救的门诊急诊局麻手术患者66例随机分为瑞芬太尼组(RF组,n=35)和芬太尼组(F组,n=31)。RF组给予静脉注射瑞芬太尼0.5μg/kg,继以微泵持续输注,并根据效果及呼吸情况在0.05～0.15μg/(kg.min)范围内随时调整;F组给予静脉注射芬太尼0.05 mg,根据效果及呼吸情况酌情追加芬太尼,每次0.05 mg,总剂量不超过0.20 mg。通过对患者术中的Ramsay镇静状态评级,统计两组的镇静效果满意率,术后对患者进行满意度评分,观察并记录两组术中、术后、随访的并发症及离院时间。结果与F组比较,RF组镇静效果满意率及术后满意度评分较高(P<0.05)、离院时间较早、术后呼吸抑制发生率较低(P<0.05)。结论小剂量瑞芬太尼0.05～0.15μg/(kg.min)泵注可安全用于门诊急诊局麻手术患者;与应用0.20 mg及其以下剂量的芬太尼比较,小剂量瑞芬太尼清醒镇痛效果更好,不良反应更少,离院时间更早。

Application of conscious sedation and analgesia for emergency patients under local anesthesia in outpatient surgery

Objective To investigate the clinical effect of remifentanil and fentanyl as awake analgesic drug in local analgesia of outpatient emergency surgery.Methods 66 patients with local analgesia in outpatient emergency surgery needing remedy of anesthetist and according with the including criteria and the excluding criteria were randomly divided into two groups,the remifentanil(RF) group(n=35) and the fentanyl(F)group(n=31).The RF group was intravenously injected with remifentanil(0.05 μg/kg),then followed by syringe pump infusion and adjusted at the range of 0.05～0.15 μg/(kg/min) according to the effects and breathing.The F group was intravenously injected with fentanyl(0.05 μg/kg) and inceased the dosage with 0.05 mg per time with a total dose less than 0.2 mg.The satisfaction rate of sedative effect was calculated respectively through RAMSAY and scored in the two groups.The intraoperative,postoperative and follow up complications and discharge time were observed and recorded during and after operation in these two groups.Results Compared with the F group,the satisfaction rate of awake analgesia and postoperative satisfactory scores in the RF group was higher(P<0.05),the discharge time was earlier and the rate of postoperative respiratory depression was lower(P<0.05).Conclusion Small-dose fentanyl 0.05-0.15 μg/(kg·min)] by pump infusion is safe to local analgesia in outpatient emergency surgery.Compared with injection of fentanyl(≤0.2 mg),small-dose fentanyl has better analgesic effct,less adverse reactions and earlier discharge time.