摘要
目的探讨静脉注射芬太尼对下肢骨折手术患者硬膜外阻滞穿刺改变体位时的镇痛作用。方法选择下肢骨折手术患者40例,随机分为两组,每组20例。于硬膜外阻滞穿刺摆侧卧体位前5min,A组静脉注射芬太尼1.5～2.0μg/kg,B组静脉注射等容量生理盐水。记录两组患者入室平卧位时(T1),给药后5min(T2),摆侧卧位时(T3),侧卧位时(T4),改平卧位时(T5)的MAP、HR、RR、SpO2及视觉模拟评分(VAS)。观察每组患者侧卧体位的满意情况及硬膜外一次穿刺成功率。结果在给药后,A组HR明显降低且低于B组(P<0.05或P<0.01),A组RR明显降低且低于B组(P<0.01),两组SpO2无统计学意义,A组VAS评分明显降低且低于B组(P<0.01),满意体位例数及一次穿刺成功率A组高于B组(P<0.05)。结论对下肢骨折手术患者硬膜外阻滞穿刺摆体位前静脉注射芬太尼能降低机体的应激反应,减轻患者的疼痛,能使患者配合体位改变,便于麻醉操作。
Objective To investigate the effect of analgesia by applying intravenous injected fentanyl on reducing pains during shifting lying positions in pre-operational anesthesia of lower limb fractures. Methods 40 lower limb fracture cases were randomly divided into 2 groups. The first 20-ease group（A） were served as experimental group,who were treated with Fentanyl 1.5-2.0μg/kg 5 minutes before epidural anesthesia, while the other 20-ease group（ B ） worked as baseline group, who were simultaneously applied with physiological saline. Records of MAP, HR, RR, SpO2 and visual analogue scale （VAS） were carefully noted clown during the 5 different positions pre-fentanyl back position （ T1 ）, 5 minutes post-Fentanyl back position （ T2 ）, side positioning （T3 ）,pre-anesthesia side position（ T4 ） and post-anesthesia back position （T5 ）. Patients, responses over different positions and the success rate of immediate anesthesia were observed. Results In post-fentanyl period, HR of group A was significantly lower than group B（ P 〈0.05 or P 〈 0.01 ）, and same as RR and VAS（P 〈 0.01 ）, SpO2 record showed no significance between both groups. Patients were more satisfied and anesthesia success rate was higher in group A （ P 〈 0.05 ）. Conclusion An intravenous injection of Fentanyl before positioning can significantly reduce patient＇ s excitability and release pains so as to make patients more flexible and cooperative in epidural anesthesia.
出处
《中华全科医学》
2009年第1期49-50,共2页
Chinese Journal of General Practice
关键词
芬太尼
镇痛
下肢骨折
硬膜外麻醉
体位
Fentanyl
Analgesia
Lower limb fracture
Epidural anesthesia
Lying position
