容量治疗在七氟醚快通道麻醉颅内动脉瘤栓塞术中的应用  

Volume therapy combined with fast track anesthesia by sevoflurane for patients undergoing intracranial aneurysm embolization

作　　者：耿擎天[1] 李娟[1] 唐朝亮[1] 康芳[1] 黄祥[1] 牛朝诗 张扬 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥230001 [2]安徽医科大学附属省立医院神经外科,脑功能与脑疾病安徽省重点实验室

出　　处：《立体定向和功能性神经外科杂志》2016年第6期351-354,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：安徽省国际科技合作计划项目(编号:1503062021)

摘　　要：目的 评价麻醉前容量治疗对七氟醚快通道麻醉颅内动脉瘤栓塞术患者围术期的影响。方法 择期全麻下行颅内动脉瘤栓塞术患者60例,性别不限,年龄18~60岁,BMI〈35kg/m2,ASA分级I-Ⅲ级,采用随机数字表法,分为2组（n=30）：容量治疗组（F组）麻醉诱导前15min输入复方乳酸钠林格氏液13ml/kg,对照组（C组）麻醉诱导前不作处理。两组术中均持续输入复方乳酸钠林格氏液10ml/min至术毕。记录患者容量治疗前（T0）、麻醉诱导前（T1）、插喉罩前（T2）、插喉罩后即刻（T3）、股动脉插管时（T4）、手术结束时（T5）、拔除喉罩时（T6）、拔喉罩后10min时（T7）、术后1h时（T8）的SP、DP和HR;记录麻醉时间、手术时间、停药后自主呼吸恢复时间和苏醒时间;记录患者术中发生低血压、血管痉挛以及血管活性药物使用情况。结果 容量治疗组低血压发生率为3例（10%）,明显低于对照组的19例（63%）（P〈0.05）;血管痉挛发生率为2例（6.7%）,明显低于对照组的5例（16.7%）（P〈0.05）;血管活性药物使用率为1例（3.3%）,明显低于对照组的7例（23.3%）。结论 麻醉前15min输入乳酸钠林格氏液13ml/kg行容量治疗,能减少七氟醚快通道麻醉颅内动脉瘤栓塞术中患者低血压和血管痉挛的发生率以及血管活性药物的使用,缩短了麻醉苏醒时间,利于神经外科医生进行早期神经功能评估。Objective anesthesia Sixty patie To evaluate the effect of preoperative by sevoflurane in patients undergoing intracranial aneur nts scheduled for 60 years,BMI 〈 35 kg/m2 ml/kg crystalloid 15 min be volume ysm em intracranial aneurysm embolization,all genders , ASA Ⅰ- Ⅲ, were randomly allocated to receive therapy for fast track bolization. Methods ,aged between 18 and either intravenous 13 fore the inducting of anesthesia（group F） or receive nothing （group C）. All groups received intravenous 10 ml/min crystalloid during the operation. Systolic blood pressure （SBP）,diastolic blood pressure （DBP）,and heart rate were recorded at eight time points （before volume therapy, before the inducting of anesthesia;before the inducting of I-gel larynge- al mask;I-gel laryngeal mask placement immediately;femoral artery intubation;the end of opera- tion;removing I-gel laryngeal mask; 10min after removing I-gel laryngeal mask; lh after the operation;Duration of anesthesia and surgery, spontaneous breathing recovery time, anesthesia re- covery time,hypotension, cerebral vasospasm, and the use of vasoactive drugs were all recorded. Results 3 patients （10%）had hypotension in group F compared to 19 （63%）in group C （P〈0. 05） ;2 patients （6.7%）had cerebral vasospasm in group F compared to 5（16.7%） in group C （P〈0.05） ;1 patient used the vasoactive drugs in group F compared to 7（23.3%） in group C（P〈0.05）. Conclusion Intravenous 13 ml/kg crystalloid 15 min before the inducting of anesthesia can reduce the incidence of hypotension,cerebral vasospasm and the use of vasoactive drugs in pa- tients undergoing intracranial aneurysm embolization under fast track anesthesia by sevoflurane. More, patients can recovery quickly from the anesthesia, and received an early neurological assess ment by neurosurgeon.

关 键 词：容量治疗 颅内动脉瘤栓塞术 七氟醚 低血压 

分 类 号：R739.4[医药卫生—肿瘤]