异丙酚、地氟醚或七氟醚复合瑞芬太尼麻醉对脑功能区手术患者术中唤醒试验的影响  

Effect of propofol, desflurane or sevoflurane combined with remifentail on intraoperative wake-up test in patients undergoing cerebral functional area operation

作　　者：崔剑[1] 陶国才[1] 王恩琴[1] 刘德行[1] 杨静涛[1] 汪玉林[1] 吴南[2] 

机构地区：[1]第三军医大学西南医院麻醉科,重庆市400038 [2]第三军医大学西南医院神经外科,重庆市400038

出　　处：《中华麻醉学杂志》2008年第6期540-542,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨异丙酚、地氟醚或七氟醚复合瑞芬太尼麻醉对脑功能区手术患者术中唤醒试验的影响。方法择期拟行脑功能区肿瘤切除术患者60例，ASAⅠ或Ⅱ级，年龄18～60岁，随机分为3组：异丙酚组（P组）、地氟醚组（D组）及七氟醚组（S组），每组20例。静脉注射依托咪酯0．3mg／kg、芬太尼3μg／kg、维库溴铵0．1mg／kg行麻醉诱导，采用1％丁卡因喉头及气管粘膜表面麻醉后行气管插管。P组、D组和s组分别靶控输注异丙酚，血浆靶浓度2．0μg／ml，持续吸入地氟醚、七氟醚1．5MAC维持麻醉。各组均靶控输注瑞芬太尼，血浆靶浓度2．5ng／ml，唤醒试验前血浆靶浓度降为0．5ng／ml，静脉注射曲马多100mg，停用麻醉药，行唤醒试验。记录唤醒时间，观察唤醒试验时躁动及寒颤的发生情况。结果各组患者唤醒时间差异无统计学意义（P〉0．05），P组寒颤发生率较D组和S组高（P〈0．05）。结论采用异丙酚、地氟醚或七氟醚复合瑞芬太尼麻醉，脑功能区手术患者术中唤醒时间无差别，地氟醚或七氟醚复合瑞芬太尼麻醉时有关并发症发生率低，更适用于术中唤醒试验。Objective To investigate the effect of propofol, desflurane or sevoflurane combined with remifentail on intraoperative wake-up test in patients undergoing cerebral functional area operation. Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-60 yr scheduled to receive awake craniotomy were randomly divided into 3 groups （n = 20 each）： propofol group （P）, desflurane group （D） and sevoflurane group （S）. Anesthesia was induced with iv injection of etomidate 0.3 mg/kg, fentanyl 3 μg/kg and vecuronium 0.1 mg/kg. Tracheal intubation was performed after all patients received topical anesthesia of larynx and tracheal mucosa with 1% tetracaine. In group P, D and S, anesthesia was maintained with TCI of propofol （target plasma concentration was set at 2.0 μg/ml） and continuous inhalation of desflumne or sevoflurane respectively. TCI of propofol was given with target plasma concentration set at 2.5 ng/ml and the concentration was decreased to 0.5 ng/ml before wake-up test in each group. Tramadol 100 mg was injected iv, anesthetic administration was terminated and wake-up test was performed. The wake-up time and bucking, restlessness and shivering during the wake up test were recorded. Results There was no significant difference in the wake-up time between the 3 groups （P 〉 0.05）. The incidence of shivering was significantly higher in group P than in group D and S （ P 〈 0.05）. Conclusion There is no significant difference in the intraoperative wake-up time in patients undergoing cerebral functional area operation during anesthesia with propofol, desflurane or sevoflurane combined with remifentail, while the incidence of complications was lower with desflurane or sevoflurane combined with remifentail and it is an appropriate anesthetic technique for intraoperative wake-up test.

关 键 词：神经外科手术 二异丙酚 哌啶类 麻醉药 吸入 

分 类 号：R614[医药卫生—麻醉学]