异丙酚和瑞芬太尼不同给药方式对颅内动脉瘤介入治疗患者麻醉效果的临床观察  

The clinical observation of target controlled infusion of propofol and remifentanil in different ways on anesthesia effect of interventional therapy of intracranial aneurysm patients

作　　者：杜雪江[1] 石海霞[1] 胡雅娟[1] 于建设[1] DU Xue-jiang SHI Hal- xia HU Ya-juan YU Jian- she(Department of Anesthesiology, the First Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China)

机构地区：[1]内蒙古医科大学第一附属医院麻醉科,内蒙古呼和浩特010050

出　　处：《现代医学》2016年第9期1176-1180,共5页Modern Medical Journal

摘　　要：目的：观察异丙酚、瑞芬太尼不同靶控输注方式对颅内动脉瘤介入治疗患者的麻醉效果。方法：择期行动脉瘤介入治疗患者120例,随机分为单次静脉推注诱导恒速泵注维持组（C组）、血浆靶控组（P组）和效应室靶控组（E组）3组。持续监测PETCO2、BIS、ABP、HR、ECG、Sp O2。记录每组患者诱导前即刻（T0）,插管即刻前（T1）,插管后1 min（T2）、3 min（T3）、5 min（T4）、10 min（T5）动脉压和心率,记录血流动力学异常发生率及血管活性药物使用次数,同时记录术后清醒拔管时间、拔管即刻和拔管后15 min以及30 min的意识状态（OAAS评分）,记录并统计异丙酚、瑞芬太尼用量。结果：3组患者T0时血压和心率差异无统计学意义;T1时P组低血压发生率（2.5%）显著低于C组（12.5%）和E组（7.5%）（P〈0.05）;C组和E组心动过缓发生率（10%）显著高于P组（2.5%）（P〈0.05）;T2~T5期间3组低血压和心动过缓发生率差异无统计学意义;C组苏醒时间较P、E组要长（P〈0.05）,异丙酚用量C组较P、E组要多（P〈0.05）,瑞芬太尼用量无明显差异。结论：异丙酚血浆药物浓度作为目标靶控输注浓度更适合动脉瘤患者的麻醉,诱导期低血压和心动过缓不良反应的发生率更低,术后清醒时间较恒速输注要短,异丙酚用量要少。Objective： To observe the target controlled infusion of propofol and remifentanil in different ways on anesthesia effect of interventional therapy of intracranial aneurysm patients. Methods： 120 patients with interventional aneurysm,were randomly divided into three groups： single intravenous injection group（ group C）,target controlled infusion group（ group P） and target effect site controlled group（ group E）. PETCO2,BIS,ABP,HR,ECG,Sp O2 were continuously monitored. The arterial pressure and HR before the time of induction（ T0）,immediately before intubation（ T1）,after intubation 1 min（ T2）,3 min（ T3）,5 min（ T4）,10 min（ T5） were recorded. The abnormal hemodynamics incidence and usage counter of vasoactive drugs were recorded. The extubation time,the state of consciousness in immediate extubation,15 min and 30 min after extubation（ OAAS score）,propofol and remifentanil dosage were recorded at the same time. Results： Three groups of patients＇ blood pressure and HR at T0 had no significant difference. The incidence of hypotension in group P（ 2. 5%） was lower than that in group C（ 12. 5%） and group E（ 7. 5%） at T1（ P〈0. 05）. The incidences of bradycardia in group C and group E（ 10%） were remarkably higher than that in group P（ 2. 5%）（ P〈0. 05）. There were no significant differences on hypotension and bradycardia during T2 to T5 in three groups. Compared with group P and E,the recovery time of group C was longer（ P〈0. 05）,propofol dosage was larger（ P〈0. 05）,there were no significant differences on the dosages of remifentanil. Conclusion： Hemodynamics is relatively stable during anesthesia using plasma target controlled infusion with propofol in patients undergoing interventional therapy for intracranial aneurysm; Patients have lower incidences of the hypotension of induction period and bradycardia using plasma target controlled infusion with propofol. The postoperative awake time of target controlled infusion is shorter than

关 键 词：靶控输注 麻醉诱导 异丙酚 瑞芬太尼 颅内动脉瘤 介入治疗 

分 类 号：R614[医药卫生—麻醉学] R739.41[医药卫生—外科学]