不同麻醉方法老年手术患者苏醒期躁动比较

目的 比较全凭静脉麻醉和静吸复合麻醉老年手术患者苏醒期躁动情况,探讨降低术后躁动的麻醉方法.方法 择期手术老年患者40例,ASA Ⅰ～Ⅱ级,完全随机法分为2组,每组20例,分别给予全凭静脉麻醉（A组）和静吸复合麻醉（B组）.2组患者全麻诱导成功后插入气管导管.A组麻醉维持采用静脉泵注丙泊酚4～6mg·kg-1·h-1、瑞芬太尼10 ～20 μg·kg-1·h-1和顺式阿曲库铵0.1～0.2 mg· kg-1·h-1.B组麻醉维持采用吸入1％ ～3％七氟醚并复合静脉泵注丙泊酚2～4 mg·kg-1·h-1、瑞芬太尼6～10μg· kg-1·h-1和顺式阿曲库铵0.1～0.2 mg· kg-1·h-1.保持2组患者的血流动力学平稳,并用肌松监测仪监测使2组患者达到相同的肌松程度,2组患者手术结束前5 min给予芬太尼2μg/kg,同时静脉接镇痛泵进行术后镇痛,所有患者未使用催醒药.记录2组患者拔管时间和躁动评分.结果 A组拔管时间、躁动发生率明显低于B组,差异有统计学意义（P＜0.05）.结论 全凭静脉麻醉可以降低老年手术患者麻醉苏醒期躁动的发生率.

Effects of different anesthetic methods on emergence agitation in elderly patients

Objective To compare the effects of different anesthetic methods on emergence agitation （EA） in elderly patients. Methods Forty ASA Ⅰ - Ⅱ atients （24 men and 16 women） aged 65 - 78 years were randomly received either intravenous general anesthesia （ group A, n = 20） or combined intravenous inhalation anesthesia （ group B, n = 20） before surgery. Group A was infused with 4 -6 mg · kg-1 · h -1 propofol, 10 -20 μg · kg-1 · h-1 remifentanil and 0.1 -0.2 mg · kg-1· h-1 syn- atracurium. Group B was maintained with 1% -3% sevoflurane through inhalation com- bined with 2 -4 mg· kg-1· h-1 propofol, 6 - 10 μg ·kg-1 · h-1 remifentanil and 0.1 -0.2 mg · kg-1 · h-1 syn - at- racurium through intravenous infusion. During operation, all patients presented stable hemodynamics and the same degree of muscle relaxation. All patients were intravenously injected with 2 μg/kg fentanyl 5 min before the end of operation, while PCIA were adopted for post - operative analgesia. The restlessness score （RS） and the time of extubation were recorded. Results In group A, the restlessness score （RS） and the time of extubation were significantly less than those in group B （ P 〈 0.05 ）. Conclusion Intravenous general anesthesia can significantly reduce the incidence of emergence agitation in elderly patients after surgery.