目的 研究瑞芬太尼复合丙泊酚用于患者清醒状态下肩关节脱位手法整复术的可行性。 方法 选择美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级，于我院行肩关节脱位手法复位患者，按照随机数字表法分为两组，每组30例。A组：以臂丛神经阻滞麻醉方法下行手法复位。B组：采用瑞芬太尼?蛳丙泊酚?蛳利多卡因复合液缓慢静脉泵注麻醉方法下行手法复位。麻醉成功后，两组患者均采用拔伸足蹬法（Hippocrates）进行复位。观察两组患者复位过程生命体征变化、术中记忆情况、呼吸遗忘（呼吸间隔大于15 s）发生情况以及视觉模拟评分法（visual analogue score， VAS）比较，复位时间、离室时间、术后满意度情况比较。 结果 两组患者均能顺利完成手法复位，A组患者复位时血压、心率较B组患者变化明显，差异有统计学意义（P<0.05），B组患者阻滞/给药后、复位即刻心率较A组患者比较下降明显（P<0.05），差异有统计学意义。两组患者阻滞/给药后、复位即刻、复位成功后血压、心率较术前基础值均有所下降，差异有统计学意义（P<0.05）。B组患者麻醉诱导时间、复位时间、离室时间明显短于A组，术后满意度B组100%，A组为90% ，VAS评分B组1.5分，A组2.4分，差异有统计学意义（P<0.05）。两组患者呼吸遗忘（呼吸间隔大于15 s）发生率B组为43.3%，A组患者无此现象发生，两组患者比较差异有统计学意义（P<0.05）， B组14例患者术后存在术中记忆遗忘现象，占病例总数的46.7%，A组无此现象发生，两组比较差异有统计学意义（P<0.05）。 结论 瑞芬太尼?蛳丙泊酚?蛳利多卡因复合液能够安全用于患者清醒状态下实施肩关节脱位手法整复术，具有临床推广价值。
Ｏｂｊｅｃｔｉｖｅ To study the feasibility of propofol and remifentanil for manipulation of shoulder dislocation reduction under the patients awake. Methods The patients wereselectes whose ASA grade were Ⅰ-Ⅱ leve， treated with houlder dislocation reduction in ourhospital. The patients were randomly divided into two groups. There were 30 cases in each group. Group A： the patients were treated with manipulative reduction under brachial plexus block. Group B： the patients were treated with manipulative reduction under remifentanil - propofol and lidocaine compound anesthesia. After successful anesthesia， two groups of patients were treated with drawing thrusting method（Hippocrates） to reset. The following signs of the two groups of patients were observed： the changes of vital signs in the reset process， memory of the operation condition， forget breathing （breathing interval is more than 15 s） and the comparison of the visual analogue score（VAS）， reset time， away from the room time， comparison of postoperative satisfaction. Results Two groups of patients were able to successfully completed in manipulative reduction. The patients blood pressure and heart rate during reset in group A were significant changed when compared with group B（P<0.05）. The patients heart rate in group B were significantly lower than group A after blocking and resetinstantly （P<0.05）. The patients anesthesia induction time， reset time and away from the room time in group B were all significantly shorter than group A. Postoperative satisfaction in group B were 100%， and 90% in group A. The VAS score in group B were 1.5， and in group A were 2.4. There were significantly different between the two groups （P<0.05）. The breath forgotten （breathing interval greater than 15 s） rate were 43.3% in group B， but without this phenomen in the group A. There were significantly different between the two groups（P<0.05）. 14 patients existed Intraoperativememory forgetting phenomenon in the group B after the operation， which were 46.7% of the total cases. There was not this phenomenon in the group A. There were significantly different between the two groups（P<0.05）. Conclusions Remifentanil-propofol and lidocaine compound liquid can be safely used for the implementation of shoulder joint dislocation technique patients in awake state. The research hasa clinical value.
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