冯春林

【摘要】 目的 分析瑞芬太尼復合丙泊酚在骨折及关节脱位手法复位中的麻醉效果。方法 50例行手法复位的骨折及关节脱位患者， 按照数字随机方式分成对照组和实验组， 每组25例， 对照组采用丙泊酚麻醉， 实验组采用瑞芬太尼复合丙泊酚进行麻醉处理。观察两组患者的麻醉效果。结果 对照组患者的麻醉起效用时为（1.4±1.0）min， 手术用时为（10.4±3.8）min， 苏醒用时为（3.5±1.5）min， 离院用时为（20.3±4.2）d；实验组患者的麻醉起效用时为（1.3±0.6）min， 手术用时为（4.1±2.7）min， 苏醒用时为（1.2±1.1）min， 离院用时为（13.1±2.6）d；两组患者麻醉起效用时比较差异无统计学意义（P>0.05）；实验组在手术用时、苏醒用时以及离院用时方面均显著短于对照组， 差异具有统计学意义（P<0.05）。麻醉后两组患者的心率（HR）、平均动脉压（MAP）均低于麻醉前， 但比较差异无统计学意义（P>0.05）；对照组患者麻醉前的血氧饱和度（SpO2）为（99.2±0.6）%， 麻醉后为（92.3±1.1）%， 实验组患者麻醉前的SpO2为（99.4±0.4）%， 麻醉后为（92.5±0.7）%， 麻醉后两组患者的SpO2均显著低于麻醉前（P<0.05）。 对照组患者中发生明显体动17例（68.0%）；实验组患者中发生明显体动1例（4.0%）；实验组患者体动发生率显著低于对照组（P<0.05）。结论 在骨折及关节脱位手法复位中应用瑞芬太尼复合丙泊酚具有比较显著的麻醉效果， 而且安全可靠， 具有临床应用价值。

【关键词】 瑞芬太尼；丙泊酚；骨折；关节脱位；手法复位

DOI：10.14163/j.cnki.11-5547/r.2016.36.052

【Abstract】 Objective To analyze anesthetic effect by remifentanil combined with propofol in manual reduction for fracture and dearticulation. Methods A total of 50 patients receiving manual reduction for fracture and dearticulation were divided by random number table into control group and experimental group， with 25 cases in each group. The control group received propofol for anesthesia， and the experimental group received remifentanil combined with propofol for anesthesia. Anesthetic effects in both groups were observed. Results The control group had anesthesia onset time as （1.4±1.0） min， operation time as （10.4±3.8） min， recovery time as （3.5±1.5） min， and discharge time as （20.3±4.2） d. The experimental group had anesthesia onset time as （1.3±0.6） min， operation time as （4.1±2.7） min， recovery time as （1.2±1.1） min， and discharge time as （13.1±2.6） d.

There was no statistically significant difference of anesthesia onset time between the two groups （P>0.05）. The experimental group had obviously shorter operation time， recovery time and discharge time than the control group， and the difference had statistical significance （P<0.05）. After anesthesia， both groups had lower heart rate （HR） and mean arterial pressure （MAP） than those before anesthesia， while their difference had no statistical significance （P>0.05）. The control group had oxyhemoglobin saturation （SpO2） as （99.2±0.6）% before anesthesia and （92.3±1.1）% after anesthesia. The experimental group had SpO2 as （99.4±0.4）% before anesthesia and （92.5±0.7）% after anesthesia. Both groups had much lower SpO2 after anesthesia than those before anesthesia （P<0.05）. The control group had 17 cases with obvious movement （68.0%）， and the experimental group had 1 case with obvious movement （4.0%）. The experimental group had obviously lower incidence of body movement than the control group （P<0.05）. Conclusion Implement of remifentanil combined with propofol in manual reduction for fracture and dearticulation provides precisely anesthetic effect. This method is safe and creditable， and it contains clinical application value.

【Key words】 Remifentanil； Propofol； Fracture； Dearticulation； Manual reduction

骨折及关节脱位是临床中发生率较高的一种骨科疾病， 选择手法复位治疗骨折及关节脱位患者能取得比较理想效果[1-3]。手法复位作为门诊小手术， 用时不长， 然而如果不对患者进行麻醉就开展手法复位治疗会让患者的痛苦增加， 并影响复位效果。本研究主要分析了瑞芬太尼复合丙泊酚在骨折及关节脱位手法复位中的麻醉效果， 现做如下总结。

1 资料与方法

1. 1 一般资料 本研究所选对象为本院2015年5月～2016年4月收治的50例行手法复位的骨折及关节脱位患者， 术前胸部X线片、心电图以及血常规检查结果正常。其……