颈总动脉输注异丙酚维持全身麻醉的临床观察  

Efficacy of continuous propofol infusion via the common carotid artery for general anesthesia

作　　者：盖成林[1] 陈卫民[1] 冉德春[2] 陆立[3] 郑晓春[4] 艾长良[2] 潘杨[2] 肖艳玲[2] 孙正清[2] 苏芳[2] 

机构地区：[1]中国医科大学附属盛京医院麻醉科,辽宁沈阳110001 [2]解放军第230医院麻醉科,辽宁丹东118000 [3]解放军第230医院普通外科,辽宁丹东118000 [4]福建省立医院麻醉科,福建福州350001

出　　处：《南方医科大学学报》2008年第8期1422-1424,共3页Journal of Southern Medical University

摘　　要：目的观察人颈总动脉持续输注异丙酚的麻醉效果。方法择期腹部手术患者40例,随机分为颈总动脉组(IC组,n=20)和静脉组(IV组,n=20)。静脉麻醉诱导气管插管控制呼吸后,通过颈总动脉或肘正中静脉持续输注异丙酚直至麻醉深度指数(CSI)等于40±5,并维持CSI在此水平波动直至手术结束停药。术中间断静脉注射芬太尼(3!g·kg-1·h-1)和维库溴铵(50"g·kg-1·h-1)维持镇痛和肌肉松弛。观察两组患者在整个手术维持期间异丙酚的用量、血流动力学变化和苏醒情况。结果颈总动脉和静脉给药达CSI=40±5并维持至术终异丙酚的用量分别为(2.57±0.67)mg·kg-1·h-1和(5.72±1.37)mg·kg-1·h-1(P<0.01)。在此麻醉深度下,IC组在维持麻醉初期近半数患者血压持续升高,有的甚至大于其基础值的30%以上,而IV组血压基本平稳,维持在低于基础血压15%水平波动。停药恢复阶段,IC组自主呼吸恢复和清醒速度均明显快于IV组(P<0.05)。结论颈总动脉持续输注异丙酚与静脉给药一样可用于麻醉维持,但用药量仅为静脉给药的1/2。Objective To investigate the efficacy of continuous propofol infusion via the common carotid artery for general anesthesia. Methods Forty adult patients scheduled for abdominal surgery were randomly assigned into 2 groups to receive propopol via the common carotid artery （IC group, n=20） or via the median cubital vein （IV group, n=20）. Anesthesia was induced with intravenous administration of drugs and maintained with continuous propofol infusion via the common carotid artery or the median cubital vein, with the CSI stabilized at 40±5 till the end of the operation. During the anesthesia, intravenous injection of fentanyl （3 μg·kg^-1·h^-1 and vecuronium （50 μg·kg^-1·h^-1 were given intermittently to maintain the analgesia and muscular relaxation. The dose of propofol used, hemodynamics and recovery of the patients were observed. Results The dose of propofol used during the surgery to maintain a CSI of 40±5 was significantly lower in group IC and than in group IV （2.57±0.67 vs 5.72±1.37 mg·kg^-1·h^-1 P〈0.01）. In group IC, the blood pressure was elevated in more than half of the patients and in some cases, the elevation exceeded one third of baseline value and needed intervention with hypotensive drugs. In the IV group, the patients＇ blood pressure remained stable and varied within the amplitude of 15% of the baseline level. Recovery of spontaneous breathing and consciousness was more quickly in group IC than in group IV （P〈0.05）. Conclusion Loss of consciousness and nervous reflex can be achieved with propofol infusion via the common carotid artery, which reduces propofol dose by about 50% in comparison with intravenous infusion and allows more rapid recovery of spontaneous breath and consciousness.

关 键 词：颈总动脉 麻醉 静脉 二异丙酚 

分 类 号：R614.2[医药卫生—麻醉学]