右美托咪定联合瑞芬太尼用于清醒开颅手术的麻醉体会  

Application of dexmedetomidine combined with remifentanil in anesthesia of awake craniotomy

作　　者：张倩[1] 张久祥[1] 王韶双[1] 白晓光[1] 

机构地区：[1]第四军医大学西京医院麻醉科,陕西西安710032

出　　处：《中华神经外科疾病研究杂志》2016年第6期523-525,共3页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨全程清醒开颅切除功能区脑肿瘤手术的麻醉方法的安全性,有效性及舒适性。方法回顾性分析11例行脑功能区脑肿瘤切除术的患者。患者建立静脉通路后,开始持续泵注右美托咪定0.5μg/kg和瑞芬0.06μg/(kg·min),术中患者保留自主呼吸,并根据呼吸次数及呼气末二氧化碳随时调节药物泵注速度。记录患者入室时(T_1),放置三钉头架时(T_2)、开颅时(T_3)、定位切除脑肿瘤时(T_4)各时间点的平均动脉压(MAP)、心率(HR)、呼吸次数(RR),并记录术中有无发生上呼吸道梗阻、术中是否使用血管活性药物。结果所有手术均顺利完成,无一例出现语言和运动功能障碍,无一例发生术中严重上呼吸道梗阻。放置三钉头架时血压稍有升高,但与入室时平均动脉压相比无统计学意义(P>0.05),开颅时血流动力学平稳,平均动脉压与入室时相比无统计学意义(P>0.05)。有一例患者出现轻度打鼾,SpO_2下降至90%,但将患者叫醒后SpO_2便上升至100%。结论术前充分的与患者沟通,完善的神经阻滞及局麻,术中患者成功的配合,右美托咪定及瑞芬太尼联合泵注,用于全程清醒开颅手术是一种安全、有效、舒适的麻醉方式。Objective The safety, effectiveness and comfort of anesthesia in awake craniotomy for resection of brain tumor in functional area are discussed. Methods A total of 11 cases of awake craniotomy for resection of brain tumor in functional area were analyzed retrospectively. Continuous infusion of dexmedetomidine with 0.5 μg/kg and remifentanil with 0. 06 μg/（kg·min） was established immediately by venous pathway. The patients should maintain spontaneously breathing during the operation, and adjust the pump injection speed according to the respiratory rate （RR） and end-tidal CO2 （EtCO2 ）. The change of mean arterial pressure （MAP）, heart rate （HR）, and RR were recorded at time of the patient going into the operation room （T1 ）, placing three nail head frame （T2 ）, removing the skull （T3 ） and the brain tumor resection （T4 ）, and the time of upper respiratory tract obstruction and dosage of vasoactive drugs were also recorded. Results All operations were completed safely, and no one has language and sensorimotor dysfuntion and severe upper respiratory tract obstruction. The blood pressure increased when placing three nail head frame, but there was no significant difference compared with T1 （P 〉 0. 05） ; the hemodynamic was stable when removing the skull, and also there was no significant difference between T1 and T3 （P 〉0.05）. One case snored and the SpO2 dropped to 90%, and then rose immediately when waking up. Condusion Sufficient pre- operative communication with patients, good nerve block and local anesthesia, and good cooperation of patients, continuous infusion of dexmedetomidine combined with remifentanil can be a safe, effective and comfortable anesthesia in awake craniotomy.

关 键 词：胶质瘤 清醒开颅 右美托咪定 瑞芬太尼 局麻 

分 类 号：R739[医药卫生—肿瘤]