小剂量瑞芬太尼辅助臂丛麻醉在显微手外科手术中的应用

目的：观察持续微量泵入瑞芬太尼辅助臂丛麻醉在显微手外科手术中的安全性和有效性.方法：80例行显微手外科手术患者,ASAⅠ～Ⅱ级,随机分成研究组（A组）和对照组（B组）,每组40例.A组用2%利多卡因10 ml＋0.75%左旋布比卡因10 ml行患侧肌间沟臂丛神经阻滞,手术开始前以0.04～0.10 ug·kg-1·min-1持续泵注瑞芬太尼.B组以同样的方法行臂丛麻醉,若术中患者疼痛不适,单次追加芬太尼0.05 mg或局麻药封闭阻滞.观察两组患者在麻醉前,手术开始10 min,手术开始30 min,手术开始50 min以及术毕时的MAP、HR、SpO2、RR.以VAS评分作为疼痛程度的评价指标.记录两组患者发生止血带反应的例数及不良反应.结果：研究组患者术中各时点血压、心率较平稳（P〉0.05）;对照组患者手术开始30 min,手术开始50 min的 MAP、HR较手术开始时升高明显（P〈0.05）;两组VAS评分存在较大差异性（P〈0.05）.结论：小剂量瑞芬太尼持续泵注可增强臂丛阻滞的麻醉效果,达到较好的镇痛,对循环、呼吸影响小且能有效抑制止血带反应的发生.

Applications of low dose remifentanil-assisted brachial plexus anesthesia in hand microsurgical operation

Objective ：To observe safety and effectiveness of remifentanil assisted-brachial plexus anesthesia through continu-ous micro-pumping in hand microsurgical operation. Methods：Eighty patients for the hand microsurgical operation, ASA I-II level, were randomly divided into experimental group （A group, 40 cases） and control group （B group, 40 cases）. A group was given 2% lidocaine 10ml and 0.75% levobupivacaine 10ml for interscalene brachial plexus block in the affected side, and continuously pumped remifentanil at 0. 04-0. 10 ug · kg^-1 · min^-1 before the operation. B group was given the brachial plexus anesthesia through the same method, and was additionally given 0.05rag remifentanil or local anesthetics to close the block if there were intraoperative pains and discomfort. MAP, HR, SpO2 and RR of the two groups were observed before the anesthesia, 10, 30 and 50 minute after the operation beginning, and at the end of the operation. VAS score was used as the assessment index of the pain. The cases suffering from tourni- quet reaction and the adverse reactions were recorded. Results： At each time point, blood pressure and heart rate of the patients in ex-perimental groups were stable （ P〉0.05 ）. The MAP and HR of the patients in B group 30 and 50 minutes after the operation beginning increased significantly （P〈0.05）. The VAS scores of two groups were obviously different （P〈0.05）. Conclusions ： Continuously mi-cro-pumping low dose remifentanil can enhance the anesthetic effect of brachial plexus block, achieve better analgesia, has a little in-fluence on circulatory system and circulatory system, and restrain the tourniquet reaction effectively.