瑞芬太尼联合臂丛神经阻滞用于上肢手术的临床观察

目的观察瑞芬太尼持续静脉泵注联合臂丛神经阻滞用于上肢手术的麻醉效果。方法随机将70例拟行单侧上肢手术的患者分为两组,两组患者均行臂丛神经阻滞。A组为芬太尼组,B组为瑞芬太尼组,每组各35例。B组持续静脉泵注瑞芬太尼0.05μg/（kg.min）,直至手术结束。术中当患者VAS评分〉3或出现体动反应时,A组追加芬太尼0.05mg静脉滴注;B组增加瑞芬太尼泵入剂量0.01μg/（kg.min）观察并记录患者围麻醉期血流动力学和呼吸参数（HR.MAP.RR.SPO2）变化,麻醉镇痛效果及术中体动反应发生率。结果两组患者围麻醉期血流动力学和呼吸参数（HR.MAP.RR.SPO2）变化无显著差异（P〉0.05）;两组患者镇痛效果差异无统计学意义（P〉0.05）;瑞芬太尼组（B组）术中体动反应发生率显著低于芬太尼组（A组）（P〈0.05）。结论瑞芬太尼持续静脉泵注联合臂丛神经阻滞用于上肢手术,对呼吸、循环影响轻微,麻醉效果良好,可供临床选择应用。

Clinical observation of remifentanil combined with brachial plexus nerve block used in the operation of arm

Objective To observe the anesthetic effect of remifentanil continuous vencolysis combined with brachial plexus nerve block used in the operation of arm. Methods Seventy patients, undergoing arm’s operation were randomly divided into fentanyl group （group A, n=35） and remifentanil group （group B, n=35）.All patients underwent brachial plexus nerve block. Group B, remifentanil continuous venoclysis 0. 05 μ g / （kg . min） until the end of operation. When VAS score 3 or body motion reaction occurred, fentanyl 0.05mg was infused in group A; increase remifentanil dose 0.01 μ g/（kg . min） in group B. Observe and note the changes of hemodynamic and inspiration parameters （HR, MAP, RR, SPO2）, VAS score and body motion reaction occurring rate during anesthetic period. Result There was no significant difference in the changes of hemodynamic and inspiration parameters between the two groups （P0.05）; there was no significant difference in the analgesic effects between the two groups （P0.05） ; there was significant difference in body motion reaction occurring rate between the two groups （P0.05）. Conclusion Remifentanil continuous venoclysis combined with brachial plexus nerve block used in the operation of arm, it has little influence on respiration and circulation system, anesthetic effect good. It can be a choice for clinical application.