保留呼吸气管插管全身麻醉在颅脑手术中的临床应用研究  

The clinical investigation of retention respiration intubation general anesthesia in craniocerebral operation

作　　者：牛建录 王珑[1] 王宏[1] 

机构地区：[1]甘肃省张掖市人民医院麻醉科,734000

出　　处：《中国医师进修杂志》2013年第35期5-7,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨保留呼吸气管插管全身麻醉在颅脑手术中的麻醉效果及安全性。方法选择行颅脑手术患者86例，按随机数字表法分为常规麻醉组和保留呼吸麻醉组，每组43例。常规麻醉组采用常规诱导气管插管，给药次序为咪达唑仑0．05mg／kg、芬太尼2～4μg／kg、顺阿曲库铵0．2～0．3mg／kg、丙泊酚1．0～1．5mg／kg；保留呼吸麻醉组患者采用快速诱导气管插管，给药次序为咪达唑仑0．05mg／kg、芬太尼2～4μg／kg、丙泊酚1．0～1．5mg／kg、氯化琥珀胆碱1．5mg／kg；两组插管完成后接Ohmeda7100型麻醉机控制呼吸，微量泵持续输注丙泊酚及瑞芬太尼，并吸入异氟烷维持麻醉；常规麻醉组间断静脉注射顺阿曲库铵；保留呼吸麻醉组在氯化琥珀胆碱作用消失后改用自主呼吸，根据呼吸次数调节瑞芬太尼输注速度，使呼吸次数保持在8—12次／min，记录两组术中丙泊酚、瑞芬太尼用量，追加芬太尼次数，术中气道压和呼气末二氧化碳分压（PETCO2），术中患者体动情况，拔管时间，拔管后15min警觉／镇静评分及不良反应。结果两组手术时间、术中体动次数、术中气道压及PETCO2比较差异无统计学意义（P〉0．05）。保留呼吸麻醉组术中丙泊酚、瑞芬太尼用量及追加芬太尼次数较常规麻醉组高[（69．2±13．7）μg／（kg·min）比（61．0±8．2）μg／（kg·min）、（O．19±0．06）μd（kg·min）比（0．15±0．05）μg／（kg·min）、1．5次比0次]，差异有统计学意义（P〈0．05）。保留呼吸麻醉组拔管时间明显短于常规麻醉组[（6．4±3．2）min比（11．3±4．5）min]，拔管后15min警觉，镇静评分明显低于常规麻醉组[1（1，3）分比2（1～3）分]，差异均有统计学意义（P〈0．05）。结论保留呼吸气管插管全身麻醉下行颅脑手术患者呼吸恢复早，拔管时间明显缩短，是一种安全高效的麻醉方法�Objective To study the effect and safety on the retention respiratory inhalation general anesthesia in craniocerebral operation. Methods Eighty-six patients undergoing craniocerebral operation were divided into conventional anesthesia group （group A） and retention respiratory anesthesia group （group B） by random digits table method with 43 cases each. Group A was given conventional induction and intubation, administration order： midazolam 0.05 mg/kg, fentanyl 2 - 4 μL g/kg,cisatracurium 0.2 - 0.3 mg/kg,propofol 1.0 -1.5 mg/kg;group B was given rapid induction and intubation,administration order： midazolam 0.05 mg/kg,fentanyl 2 -4 μ g/kg,propofol 1.0 - 1.5 mg/kg,succinylcholine 1.5 mg/kg. The 2 groups after intubation done by Ohmeda 7100 anesthesia machine control respiration, trace pump continuous infusion of propofol and remifentanil,and maintained inhaling isoflurane anesthesia. Group A was discontinuity intravenous injection atracurium. Group B was changed autonomous breathing after the succinylcholine effect disappeared,respiratory frequency according to the regulation of remifentanil infusion rate,the respiration rate remained at 8 - 12 times/min. The consumption of propofol and remifentanil, additional times of fentanyl,intraoperative airway pressure, partial pressure of carbon dioxide in end expiratory gas （PETCO2）, intraoperative body movement, airway pressure, extubation time, OAA/S score after extubation 15 min and untoward reaction were recorded. Results There were no statistical differences in operation time,intraoperative body movement,intraoperative airway pressure and PETCO2 between the 2 groups （P 〉 0.05 ）. The consumption of propofol and remifentanil, additional times of fentanyl in group B were significantly higher than those in group A [ （69.2 ± 13.7） μ g/（kg·min） vs. （61.0 ± 8.2）μ g/（kg ·min）, （0.19 ± 0.06） μ g/ （kg＇min） vs. （0.15 ± 0.05） μ g/ （kg·min）, 1.5 times vs. 0 time] ,there were statistical differences （P〈 0.05 �

关 键 词：麻醉 全身 颅脑手术 保留呼吸 

分 类 号：R614[医药卫生—麻醉学]