瑞芬太尼联合异丙酚或七氟醚全身麻醉用于幕上占位手术的比较  

Comparison of Propofol/remifentanil and Sevoflurane/remifentanil for Maintenance of Anaesthesia for Elective Intracranial Surgery

作　　者：项冬梅[1] 谢晓澜[1] 肖建斌[1] 

机构地区：[1]广东省中医院麻醉科,广东广州510120

出　　处：《河北医学》2007年第6期652-655,共4页Hebei Medicine

摘　　要：目的:异丙酚和七氟醚广泛用于神经外科手术麻醉的术中维持。我们对这两种药复合短效的阿片类药物瑞芬太尼进行了前瞩性的对比研究。方法:对50例神经外科择期手术病人在颅骨切开后静脉注射瑞芬太尼1μg/kg,维持由开始的0.5μg/kg.min逐渐减少至0.25μg/kg.min。麻醉诱导用异丙酚,术中麻醉维持予靶控输注异丙酚,最低靶浓度为2μg/ml。或者用初始吸入浓度2%的七氟醚吸入。术中平均动脉压大于100mmHg或低于60mmHg分别视为高血压或低血压。分别记录手术方案、麻醉期间血流动力学、麻醉药用量以及麻醉后恢复情况。结果:98例病人随机分为两组:异丙酚组(P组)和七氟醚组(S组)。两组病人高血压的发生率无明显差异,低血压的发生率S组比P组高,S组的使用的血管活性药物明显比P组多。两组的苏醒时间无显著性差异。每小时的麻醉药用量S组比P组减少有显著性差异。结论:瑞芬太尼联合异丙酚或七氟醚两组都能在神经外科手术中提供良好的麻醉。Objective： Propofol and sevoflurane are suitable agents for maintenance of anaesthesia during neurosurgical procedures. We have prospectively compared these agents in combination with the short -acting opioid, remifentanil. Method： Ninty - eight unpremedicated patients undergoing elective craniotomy received remifentanil 1 μg/kg followed by an infusion commencing at 0.5μg/kg min - 1 reducing to 0.25μg/kg minafter craniotomy. Anaesthesia was induced with propofol, and maintained with either a target controlled infusion of propofol, minimum target 2 μg/ml or sevoflurane, initial concentration 2% ET. Episodes of mean arterial pressure （ MAP） more than 100 mm Hg or less than 60 mm Hg for more than 1 rain were defined as hypertensive or hypotensive events, respectively. A surgical assessment of operating conditions and times to spontaneous respiration, extubation, obey commands and eye opening were recorded. Result： Forty -four and Forty - four patients were assigned to propofol （ Group P ） and sevoflurane anaesthesia （ Group S ）, respectively. The number of hypertensive events was comparable, whilst more hypotensive events were observed in Group S than in Group P （P =0. 053, chi-squared test）. As rescue therapy, more labetolol [45 （33） vs76 （58） mg, P=0.073] and ephedrine[4.80 （2.21） vs 9.78 （5.59） rag, P=0.020] were used in Group S. Between group differences in recovery times were small and clinically unimportant. The combined hourly acquisition costs of hypnotic, analgesic, and vasoactive drugs appeared to be lower in patients maintained with sevoflurane than with propofol. Conclusion： Propofol/remifentanil and sevoflurane/ remifentanil both provided satisfactory anaesthesia for intracranial surgery.

关 键 词：麻醉 异丙酚 瑞芬太尼 

分 类 号：R614[医药卫生—麻醉学]