瑞芬太尼复合异丙酚麻醉在神经内镜辅助锁孔手术治疗颅内深部病变的应用  

Remifentanil with propofol for total intravenous infusion in neuroendoscope-assisted surgery through keyhole approach for treatmemt of intracranial deep lesions

作　　者：林赛娟[1] 田国刚[1] 唐群新[1] 吴爱珍[1] 黄玉焕[1] 

机构地区：[1]海南省海口市人民医院麻醉科,海南海口570208

出　　处：《海南医学》2007年第6期39-40,共2页Hainan Medical Journal

摘　　要：目的探讨瑞芬太尼复合异丙酚静脉麻醉在神经内镜辅助锁孔手术治疗颅内深部病变中的应用。方法选择78例颅内占位病变择期患者,ASAⅠ～Ⅱ级,随机分为二组,RP组静脉注射瑞芬太尼(2ug/kg诱导,0.2ug·kg-1·min-1维持),FP组静脉注射芬太尼(3ug/kg诱导,0.03ug·kg-1·min-1维持),复合异丙酚,且根据血压及手术情况调整异丙酚用量。记录麻醉期间血压、心率变化,异丙酚用量,拨管时间。结果瑞芬太尼或芬太尼复合异丙酚均能取得满意的麻醉效果。两组病人麻醉诱导后,血压均显著降低(P<0.01),心率显著减慢(P<0.01),且RP组较FP组明显(P<0.05),其他时段血压、心率均维持平稳,组间差异无统计学意义(P>0.05)。RP组异丙酚用量少于FP组(P<0.05),拨管时间明显短于EP组(P<0.01)。结论瑞芬太尼复合异丙酚静脉麻醉,诱导时间短,麻醉维持期血流动力学稳定,清醒较快而完全,更适于颅内显微手术。Objective To evaluate the anesthetic effect of total intravenous anesthesia （TIVA） of remifentanil with propofol in the practice of neuroendoscope-assisted surgery through keyhole approach for treatment of intracranial deep lesions. Methods Seventy-eight ASA Ⅰ or Ⅱpatients with intracranial tumors or aneurysm scheduled for microsurgery were randomly divided into two groups： RP group and FP group. RP group anesthesia was induced with remifentanil 2ug.kg^-1 and maintained with 0.2ug.kg^-1.min^-1. FP group anesthesia was induced with fentanyl 3ug.kg^-1 and maintained with 0.03ug.kg^-1.min^-1. Both groups were supplemented with propofol. And infusion rate of propofol was changed by blood pressure and surgery conditions. The hemodynamic changes, propofol dosage and recovery of anesthesia were observed in all patients. Results Remifentanil or fentanyl supplemented with propofol supplyed satisfying anesthetic efficacy for intracranial microsurgery. In all the patients, blood pressure was significantly lower（p〈0.01） and heart rate decreased after induction of anesthesia（p〈 0.01）, especially in RP group （p〈0.05）, and remained stable during the other periods. In RP group, the dosage of propofol is less than that in FP group （p〈0.05）. Remifentanil wore off faster than fentanyl （p〈0.05）. Conclusions Remifentanil with propolol for TIVA has advantages of rapid induction of anesthesia, stability of hemodynamics, rapid recovery and is more suitable for intracranial microsurgery.

关 键 词：瑞芬太尼 芬太尼 异丙酚 静脉麻醉 锁孔手术 

分 类 号：R971.2[医药卫生—药品]