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静脉快通道麻醉在老年患者脊柱手术中的应用

, PP. 674-677

Keywords: 瑞芬太尼,丙泊酚,静脉快通道麻醉,老年患者,脊柱手术

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Abstract:

目的探讨瑞芬太尼联合丙泊酚静脉快通道麻醉在老年患者脊柱手术中应用的临床效果及安全性。方法择期胸腰椎内固定减压手术60例(男34例,女26例),ASAII~Ⅲ级,年龄61~70岁,体重56~72kg。随机分为静脉麻醉组(A组)和吸入麻醉组(B组),每组30例。诱导采用咪唑安定0.04mg?kg-1,舒芬太尼0.2μg?kg-1,丙泊酚1~1.5mg?kg-1,顺苯磺酸阿曲库胺0.15mg?kg-1静注。静脉麻醉组以瑞芬太尼0.5~0.8μg?(kg?min)-1、异丙酚70~100ug?(kg?min)-1泵注维持麻醉;吸入麻醉组吸入0.5%~2%异氟烷维持麻醉。观察的指标有诱导前、插管前、插管后、切皮后及拔管后的血压、心率变化情况;停药后自主呼吸恢复时间、唤之睁眼时间和拔管时间;拔管后即刻意识状态(OAAS);苏醒期间出现寒战、肌颤、恶心、呕吐及躁动等不良反应的情况。结果两组在诱导和插管时的血流动力学相比差异无统计学意义,术中各时间段的血压无明显变化,拔管后A组血压要明显低于B组(P<0.05),A组在切皮时及拔管后心率也明显低于B组(P<0.05);麻醉诱导期两组使用血管活性药物的次数差异无统计学意义,在麻醉苏醒期,A组使用硝酸甘油降压及艾司洛尔控制心率的病人数量相比于B组明显减少(P<0.05);B组患者苏醒和拔管所需时间明显较A组长,不良反应发生率B组高于A组(P<0.05);在拔管后即刻A组中评分3分以下的仅占10%,B组中评分3分以下的占40%,两组间差异有统计学意义(P<0.05)。结论与异氟烷吸入全麻相比,在老年患者脊柱手术中应用瑞芬太尼联合丙泊酚静脉快通道麻醉,患者血流动力学更平稳,术后苏醒快,不良反应少,麻醉效果及安全性好。

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