全凭静脉麻醉应用于神经外科手术  

Application of Total Intravenous Anesthesia in Neurosurgical Operations

作　　者：廖志品[1] 李白莉[1] 罗爱林[1] 田玉科[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,武汉430030

出　　处：《医药导报》2006年第4期289-292,共4页Herald of Medicine

摘　　要：目的评价全凭静脉麻醉用于神经外科手术的可行性，并与吸入麻醉作比较。方法将60例择期颅脑手术患者，随机分为观察组（静脉麻醉）和对照组（吸入麻醉），每组30例。观察组采用注射泵持续注入异丙酚5mg·kg^-1·h^-1、利多卡因2．5mg·kg^-1·h^-1、芬太尼1．8～3．0μg·kg^-1·h^-1和阿曲库铵O．5mg·kg^-1·h^-1；对照组采用间断静脉推注维库溴铵和持续吸入异氟醚维持。连续监测脑电参数、血流动力学参数；记录麻醉恢复时间、不良反应及麻醉并发症。结果诱导后两组患者的双频谱指数（BIS）、95％边缘频率（SEF）均明显降低；观察组BIS值明显低于对照组；对照组血压、心率在诱导插管后明显升高，观察组变化较小；对照组拔管后烦躁者明显多于观察组。结论全凭静脉麻醉用于神经外科手术优于吸入麻醉。Objective To assess the feasibility of the application of total intravenous anesthesia in neurosurgical operation and to compare its effects with those of inhalation anesthesia. Methods 60 patients scheduled for craniocerebral operations were randomly divided into 2 equal groups： the trial group （for total intravenous anesthesia ） and control group （for combined IV and inhalation anesthesia）. Patients of the trial group were given each a sustained IV injection of 5 mg·kg^-1·h^-1 of propofol,2.5 mg·kg^-1·h^-1 of lidocaine, 1.8 - 3.0 μg ·kg^-1·h^-1 of fentanyl and 0.5 mg·kg^-1·h^-1 of atracutium with an injection pump. Patients of the control group wer given disconnected IV injections of vecuronium bromide combined with inhalation of isoflurance. Electroencephalographic and hemodynamic parameters of the patients were continuously monitored. The time of recovery from the anesthesia, adverse reactions and complications of anesthesia were noted down. Results The hispectral index （BIS）and 95 % spectral edge frequency（SEF ） in patients of both groups were significantly decreased after the induction of anesthesia and the BIS in patients of the trial group was strikingly lower than that of the control group. The mean arterial blood pressure （MAP） was elevated and heart rate increased significantly in patients of the control group after the induction of anesthesia and intratracheal inhalation. Changes in these 2 parameters were moderate in patients of the trial group. Symptoms of restlessness were more frequently observed in patients of the control group than in those of the trial group after the extubation. Conclusion The total intravenons anesthesia was shown to be superior to inhalation anesthesia in craniocerebral operations.

关 键 词：全凭静脉麻醉 吸入麻醉 神经外科手术 

分 类 号：R971.2[医药卫生—药品] R614.2[医药卫生—药学]