丙泊酚复合瑞芬太尼或右美托咪定在老年患者慢性硬膜下血肿手术中的应用

目的对比观察丙泊酚复合瑞芬太尼或右美托咪定用于老年患者慢性硬膜下血肿清除手术的有效性与安全性。方法 80例拟行慢性硬膜下血肿清除术的患者,随机分为2组:丙泊酚复合右美托咪定组(D组)、丙泊酚复合瑞芬太尼组(R组),另辅助术区局部浸润麻醉下完成手术。观察并记录HR、MAP、RR、SpO_2、PETCO_2、术中肢体躁动情况和不良反应发生率。结果所有病例均能完成操作,切皮后(T_4)、颅骨钻孔时(T_5)R组的MAP低于D组(P<0.05),T_3(局麻时)~T_5HR高于D组(P<0.05),T_2~T_5时RR低于D组(P<0.05),T_3~T_5时SpO_2和PETCO_2高于D组。R组肢体躁动次数少于D组(P<0.05),呼吸抑制次数多于D组(P<0.05),两组呼吸道梗阻次数比较差异无统计学意义(P>0.05),两组患者均无恶心呕吐和反流误吸发生。结论丙泊酚复合瑞芬太尼或右美托咪定均可安全用于老年患者慢性硬膜下血肿清除手术。前者镇痛效果更可靠,苏醒更快;后者呼吸系统并发症更少。

Application of propofol combined with remifentanil or dexmedetomidine in surgery for elderly patients with chronic subdural haematoma

Objective To investigate the efficacy and safety of propofol combined with dexmedetomidine or remifentanil in surgery for elderly patients with chronic subdural hematoma (CSDH). Methods Eighty elderly pa-tients undergoing CSDH were randomly divided into 2 groups:group D ( dexmedetomidine combined with propofol) and group R (remifentanil combined with propofol),40 cases in each group. Local anesthesia was performed before skin incision. The HR,MAP,RR,SpO2 and PETCO2 were recorded. The agitation and adverse reactions during opera-tion were recorded. Results The operations of all the patients were completed. Compared with group D,the variation in MAP after skin incision ( T4 ) and at the time of sphenotresia ( T5 ) ,the variation in HR at the time of local anesthe-sia (T3),T4 and T5,and the variation of RR at T2 ~T5 in group R were lower (P<0. 05);the variation of SpO2 and PEtCO2 at T3 ~T5 was higher (P<0. 05). The incidence of agitation in group R was lower than that of group D (P<0. 05) with higher incidence of respiratory depression (P<0. 05). There was no significant difference in airway ob-struction between the two groups (P>0. 05). No nausea,vomiting or reflux was observed. Conclusion Propofol com-bined with dexmedetomidine or remifentanil can meet the requirement of surgery for elderly patients with CSDH. Propofol combined with dexmedetomidine has better analgesic effect and faster recovery,while the other regimen has less respiratory complications.