丙泊酚复合芬太尼或咪达唑仑在三叉神经痛射频温控热凝术中的运用  

Combined Application of Propofol,Fentanyl and Midazolam in Radiofrequency Thermocoagulation in Patients with Trigeminal Neuralgia

作　　者：张培红[1] 徐辉[1] 姜红[1] 

机构地区：[1]上海交通大学附属第九人民医院麻醉科,上海200011

出　　处：《中国现代医生》2009年第36期8-9,12,共3页China Modern Doctor

摘　　要：目的比较丙泊酚复合芬太尼或咪达唑仑在三叉神经痛患者的射频温控热凝术中的麻醉效果。方法择期行射频温控热凝术ASAI-Ⅱ级的三叉神经痛患者60例,随机分为两组:咪达唑仑-芬太尼-丙泊酚(Ⅰ组)和芬太尼-丙泊酚(Ⅱ组)。于麻醉诱导前(基础值),穿刺时,意识消失时,加温1min、3min和术毕时记录SBP、DBP、HR、SPO2;记录丙泊酚的用量,睫毛反射消失、睁眼及治疗室停留的时间;记录治疗过程中的不良反应发生率。结果两组意识消失时间,呼之睁眼时间,治疗室停留时间差异无统计学意义(P>0.05);与Ⅱ组比较,Ⅰ组丙泊酚用量减少,不良反应和术中知晓的发生率降低(P<0.05或P<0.01)。与基础值比较,两组在穿刺、意识消失时,加温1min时,加温3min时的SBP、DBP、HR均降低(P<0.01),SpO2无统计学意义(P>0.05);与Ⅱ组比较,Ⅰ组意识消失时,加温1min,加温3min时的SBP升高(P<0.05),DBP、HR、SpO2在以上各时点及SBP在穿刺时的差异无统计学意义(P>0.05)。结论丙泊酚-芬太尼复合小剂量咪达唑仑可增强镇静镇痛作用,减少药物用量,减少药物的不良反应,且不影响麻醉的恢复,是三叉神经射频温控热凝治疗术的一种安全有效的麻醉方法。Objective To compare the anesthetic effects of combined application of Propofol,Fentanyl and Midazolam in radiofrequency thermocoagulation in patients with trigeminal neuralgia. Methods Sixty patients with ASA l-ll trigeminal neuralgia were divided randomly into two groups： group Ⅰ （n=30）, and group Ⅰ ＂＊＇as Midazolam-Fentanyl-Propofol group,and group Ⅱ （n=30） was Fentanyl- Propofol group. SBP,DBP,HR and SpO2 were recorded before anesthesia,in acupuncture,when consciousness disappeared,and in heating 1 min and 3 min and the end of the surgery,respectively. The dose of propofol,the time of eyelash reflex disappearance （sec）,eyes opening when called and stay in the treatment room and adverse reactions in treatment were also recorded. Results There was no significant difference between two groups in the the time of eyelash reflex disappearance,eye opening when called and stay in the therapy room（P〉0.05 ）. The dose of Propofol, incidence of adverse reactions and intraoperative awareness in group Ⅰ were lower t han those in group Ⅱ（P〈0.05 or P〈0.01）. Compared with baseline,there was no significant difference in SpO2 between the two group（P〉0.05）, while SBP, DBP and HR were all lowered in both groups before anesthesia, in acupuncture, when consciousness disappeared, and in heating 1 min and 3 min and the end of the surgery（P〈0.01）. SBP when consciousness disappeared, and in heating 1 min and 3 rain was higher in group Ⅰ than that in group Ⅱ （P〈0.05）, and there was no significant difference in DBP,HR and SpO2 at above-mentioned time points between two groups（ P〉0.05 ）. Furthermore, there was no significant difference in SBP between the two groups in acupuncture（P〉0.05）. Conclusion The combined use of Propofol,Fentanyl and small dose of Midazolam can enhance the effect of analgesia and sedation,reducing the drug adverse reactions and dose of drugs,and having no impact on recovery. It is a safe and effective method of anesthesia in radiofrequency

关 键 词：三叉神经痛 射频温控热凝术 丙泊酚 咪达唑仑 

分 类 号：R745.11[医药卫生—神经病学与精神病学]