常永俊 何文胜 王凯

[摘要]目的：研究分析小劑量瑞芬太尼复合右美托咪定在断指再植术中的麻醉效果及安全性。方法：选取笔者医院收治的78例行断指再植术的患者随机分为常规组和小剂量组，各组39例。所有患者均进行肌间沟臂丛神经阻滞，常规组给予常规剂量瑞芬太尼复合右美托咪定麻醉，小剂量组给予小剂量瑞芬太尼复合右美托咪定麻醉。对比两组患者麻醉即刻（T0）、术中30min（T1）、术中2h（T2）及术毕（T3）的平均动脉压、心率、呼吸频率;对比两组患者麻醉效果;对比两组患者T1、T2、T3时刻点的Ramsay镇静评分、疼痛视觉模拟评分法（VAS）评分;对比两组患者麻醉药物相关不良应发生情况。结果：两组平均动脉压、心率及呼吸频率均呈现先下降后升高的趋势，差异有统计学意义（P<0.05）;小剂量组患者T3时刻点平均动脉压、心率和呼吸频率均高于常规组，差异有统计学意义（P<0.05）;而其他时刻点两组患者平均动脉压、心率和呼吸频率比较差异无统计学意义（P>0.05）。两组麻醉效果分级比较差异无统计学意义（P>0.05）。两组患者麻醉后Ramsay镇静评分均随手术时间延长而降低（P<0.05），除T3时刻点小剂量组患者Ramsay镇静评分低于常规组（P<0.05），其他时刻点比较差异无统计学意义（P>0.05）。两组患者VAS镇痛评分均随手术时间延长而增加（P<0.05），两组患者同时刻点VAS镇痛评分比较差异无统计学意义（P>0.05）。小剂量组不良发应总发生率稍低于常规组，但组间比较差异无统计学意义（P>0.05），所有不良反应均在麻醉药物停用及手术结束后得到缓解。结论：小剂量瑞芬太尼复合右美托咪定在断指再植术中具有良好的麻醉效果，安全可靠，值得临床推广应用。

[关键词]瑞芬太尼;右美托咪定;断指再植术;麻醉效果;安全性

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）06-0023-04

Anesthetic Effect and Safety of Small Dose Remifentanil Combined with Dexmedetomidine in Replantation of Severed Fingers

CHANG Yong-jun，HE Wen-sheng，WANG Kai

（Department of Anesthesiology，Hefei Second People's Hospital，Hefei 230001，Anhui，China）

Abstract： Objective  To study the anesthesia effect and safety of small dose remifentanil combined with dexmedetomidine in the digital replantation. Methods  78 cases of replantation were randomly divided into the routine group and the small dose group， 39 cases in each group. All patients were performed intermuscular groove brachial plexus block. The routine group was given remifentanil combined with dexmedetomidine anesthesia， and the small dose group was given remifentanil combined with dexmedetomidine anesthesia. The mean arterial pressure， heart rate and respiratory rate were compared between the two groups at the time of anesthesia （T0）， 30 minutes during operation （T1）， 2 hours during operation （T2） and at the end of operation （T3）. The anesthesia effect of the two groups was compared. Ramsay Sedation scores and VAS scores were compared at T1， T2 and T3 in the two groups. The incidence of adverse drug-related reactions was compared between the two groups. Results  The mean arterial pressure， heart rate and respiratory rate of the two groups decreased first and then increased， the differences were statistically significant （P<0.05）. The mean arterial pressure， heart rate and respiratory frequency of the patients for T3 in the low dose group were higher than those in the routine group （P<0.05）， but there were no significant difference in mean arterial pressure， heart rate and respiratory rate between the two groups at other times （P>0.05）. There were no significant difference in anesthetic effect between the two groups （P>0.05）. Ramsay Sedation score of the two groups decreased with the prolongation of operation time （P<0.05）. The Ramsay Sedation score in the small dose group was lower than that in the routine group at T3（P<0.05）. There were no statistical difference in those between other time points （P>0.05）. The VAS scores of the two groups increased with the operation time （P<0.05）， but there were no significant difference between the two groups （P>0.05）. The incidence of adverse reactions in the small dose group was slightly lower than that in the routine group （P>0.05）， and all adverse reactions were relieved after the end of anesthesia and operation. Conclusion  Small dose remifentanil combined with dexmedetomidine has a good anesthetic effect in the digital replantation， safe and reliable， which is worthy of clinical application.

Key words： remifentanil; dexmedetomidine; digital replantation; anesthetic effect; safety

斷指再植术是目前外科常见的手术之一，得益于外科技术的显微化发展，断指再植术中精细的技术操作问题得到有效解决，极大提高了断指再植术的成活率[1]。但由于断……