瑞芬太尼联合丙泊酚在老年患者肩关节脱位手法复位术中的应用

目的：观察瑞芬太尼联合丙泊酚在老年患者肩关节脱位手法复位术中的临床应用及安全性。方法：选择拟行肩关节脱位手法复位术的老年患者60例，随机分为瑞芬太尼组（R组）、芬太尼组（F组）和臂丛神经组（N组）各20例。R组和F组给予患者静注丙泊酚1mg／kg，待患者意识消失（呼叫不能睁眼），R组静注瑞芬太尼0．25ug／kg，F组静注芬太尼1ug／kg。N组行患侧肌间沟臂丛神经阻滞，局麻药为1．3％利多卡因15mL。R组和F组推注药物完毕即刻、N组麻醉完全起效后开始采用Hippocrates法进行肩关节脱位手法复位术。观察并记录所有患者麻醉起效时间、复住时间、麻醉恢复时间、麻醉效果、发生呼吸抑制、使用阿托品或麻黄碱的例数、手术医生满意度。结果：R组和F组麻醉起效时间明显短于N组（P〈0．05）；3组患者复位时间比较差异无统计学意义（P〉0．05）；R组和F组麻醉恢复时间明显短于N组（P〈0．05），且R组比F组更短（P〈0．05）；R组和F组麻醉效果优良率和手术医生满意度明显高于N组（P〈0．05），且R组手术医生满意度高于F组（P〈0．05）。结论：瑞芬太尼联合丙泊酚用于老年患者肩关节脱位手法复位术起效快，麻醉效果满意，恢复快，手术医生满意度高，值得在临床上应用。

Clinical Application of Remifentanil combined with Propofol Intravenous Anesthesia for Shoulder Joint Reduction in the Elderly

Objective：To observe the clinical effect and safety of remifentanil combined with propofol intravenous anesthesia for shoulder joint reduction in the elderly. Methods：Sixty old patients with dislocation of shoulder joint were randomly divided into Remifentanil group （group R）, Fentanyl group （group F）, and brachial plexus nerve block group （group N）. Group R and group F received propofol lmg/kg intravenously firstly. After the patients lost their consciousness, group R and group F respectively received remifentanil 0.25？ g/kg and fentanyl lg/kg intravenously. Group N underwent brachial plexus block withl. 3% lidoeaine 15ml. The shoulder joint received manipulative reduction by Hippocrates method when the anesthesia worked. The anesthesia reaction time, operation time, anesthesia recovery time, anesthesia effect, cases receiving atropine or ephedrine and respiratory depression, and satisfactory degree of the surgeons were recorded. Results： Anesthesia reaction time in group R and group F were significantly shorter than that in group N （P〈0.05）. There was no statistical difference in operation time among three groups （P〉0.05）. Anesthesia recovery time in group R and group F were remarkably shorter than that in group N （P〈0.05）, with shorter time in group R than in group F （P〈0.05）. The rate of excellent and good rate in anesthesia effect and the satisfactory degree of surgeons in group R and group F were higher than that in group N（P〈0. 05）, and the satisfactory degree of surgeon in group R was higher yet than that in group F（P〈0.05）. Conclusion..Remifentanil combining propofol intravenously have the following advantages in shoulder joint reduction for the elderly： fast onset, satisfactory anesthesia, quick recovery and high satisfactory degree of surgeons. Thus, it is suitable for wide clinical application.