【摘要】：目的:探討聯(lián)合應(yīng)用右美托咪定和舒芬太尼對(duì)慢性硬膜下血腫鉆孔引流術(shù)患者麻醉效果的影響。方法:96例慢性硬膜下血腫行鉆孔引流術(shù)患者隨機(jī)均分為D組和DS組(每組均為48例)。當(dāng)2組患者的Ramsay鎮(zhèn)靜評(píng)分(RSS)達(dá)到3分時(shí),于鉆孔處行局部浸潤(rùn)麻醉。分別記錄2組患者的麻醉起效時(shí)間、術(shù)中血流動(dòng)力學(xué)變化、需要實(shí)施補(bǔ)救藥物的人數(shù)、初次使用補(bǔ)救藥物的時(shí)間、術(shù)中患者體動(dòng)次數(shù)、術(shù)后恢復(fù)時(shí)間、患者和外科醫(yī)師的滿意度、藥物相關(guān)不良反應(yīng)。結(jié)果:與D組相比,DS組患者麻醉起效時(shí)間明顯降低(13.68±3.13 vs.11.82±2.43 min,P=0.002)。D組患者需要更多咪達(dá)唑侖來達(dá)到術(shù)前設(shè)定的鎮(zhèn)靜標(biāo)準(zhǔn)(31.25%15/48 vs.12.50%6/48,P=0.023),與D組相比,DS組患者需要芬太尼補(bǔ)救者(10.42%5/48 vs.27.08%13/48,P=0.036)和總需要量(89.48±23.27 vs.125.28±33.52μg,P=0.000)明顯減低,芬太尼初次使用時(shí)間(18.34±4.45 vs.14.34±3.63 min,P=0.000)明顯延長(zhǎng)。與此同時(shí),D組患者體動(dòng)次數(shù)明顯多于DS組(35.42%17/48 vs.16.67%8/48,P=0.036),術(shù)后恢復(fù)時(shí)間明顯長(zhǎng)于DS組(17.54±5.92 vs.12.57±5.28 min,P=0.000),且患者和外科醫(yī)師的滿意度評(píng)分明顯低于DS組(P0.05)。D組患者術(shù)中心動(dòng)過緩(37.50%18/48 vs.18.75%9/48,P=0.041)和低血壓(37.50%18/48 vs.14.58%79/48,P=0.011)的發(fā)生率較DS組高。結(jié)論:對(duì)于監(jiān)護(hù)麻醉下行慢性硬膜下血腫鉆孔引流術(shù)患者,聯(lián)合應(yīng)用右美托咪定和舒芬太尼較單純右美托咪定可以減少術(shù)中患者體動(dòng)和藥物補(bǔ)救措施及相關(guān)不良反應(yīng),可以安全有效的應(yīng)用于臨床。
[Abstract]:Objective: to investigate the effect of dexmetidine and sufentanil on the anesthesia of patients with chronic subdural hematoma. Methods 96 patients with chronic subdural hematoma were randomly divided into group D and group DS (48 cases in each group). When the Ramsay sedation score (RSS) of the two groups was 3, local infiltration anesthesia was performed at the borehole. The onset time of anesthesia, hemodynamic changes during operation, the number of patients in need of remedial drugs, the time of initial use of remedial drugs, the times of body movement during operation and the time of recovery after operation were recorded in the two groups. Patient and surgeon satisfaction, drug-related adverse reactions. Results: the onset time of anesthesia in DS group was significantly lower than that in D group (13.68 鹵3.13 鹵2.43 min P0.002). The patients in group D needed more midazolam to meet the preoperative sedative standard (31.25% 48 vs.12.506% 48% P0.023). Compared with group D, patients in DS group needed fentanyl rescuers (10.422 vs.27.08 / r -48 vs.27.08 / P 0.036) and group D needed fentanyl (10.42 / 548 vs.27.08 / r 48P 0.036) and needed more midazolam in group D than in group D (31.25% 48 vs 12.506% P 0.023). The total requirement (89.48 鹵23.27 vs.125.28 鹵33.52 渭 g P0. 000) was significantly decreased. The initial use time of fentanyl (18.34 鹵4.45 vs.14.34 鹵3.63 min P0. 000) was significantly prolonged. At the same time, the number of body movements in group D was significantly higher than that in group DS (35.42 / 48 vs.16.678 / 48 / P0.036), and the postoperative recovery time was significantly longer than that in group DS (17.54 鹵5.92 鹵5.28 vs.12.57 鹵0.000), and the satisfaction scores of patients and surgeons were significantly lower than those in group DS (P0.05) .D (37.50% 48 vs.18.759% P 0.041) and hypoglycemia (P 0.041). The incidence of pressure (37.50 / 48 vs.14.58 yr / 48 P 0.011) was higher than that in DS group. Conclusion: combined use of dexmetidine and sufentanil in patients with chronic subdural hematoma drilling and drainage under monitoring anesthesia can reduce body movement and drug remedy and related adverse reactions. It can be used in clinic safely and effectively.
【作者單位】： 鄂爾多斯市中心醫(yī)院;聊城市人民醫(yī)院;
【分類號(hào)】：R614

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