恩纳气管内麻醉在神经外科后颅凹手术的临床应用  

Clinical Application of EMLA for Endotracheal Anesthesia during Neurosurgical Operation in Cranial Fovea Posterior

作　　者：步金梅[1] 张彦[1] 李恒林[1] 

机构地区：[1]天津市脑系科中心医院麻醉科,300060

出　　处：《天津医药》2004年第1期22-24,共3页Tianjin Medical Journal

摘　　要：目的 :观察恩纳气管内麻醉用于神经外科手术及术后长期保留气管导管患者的临床效果。方法 :选择60例神经外科后颅凹手术患者 (ASAI～II级 ) ,随机分为恩纳组和非恩纳组各30例。2组均采用丙泊酚和芬太尼诱导及维持麻醉 ,监测围术期血压、心率、血氧饱和度 (SpO2)、4个成串刺激比值 (T4/T1)、边缘频率 (SEF)、双频谱指数 (BIS)等指标及体征的变化 ,记录手术前、后气管黏膜的形态学改变、气管导管并发症及药物的不良反应。结果 :恩纳组气管导管耐受优于非恩纳组 ,包括血压、心率波动和肢动、皱眉、吞咽及呛咳反应频率显著降低(P<0.05或P<0.01)。2组气管导管总留置时间差别无统计学意义 ,但恩纳组导管清醒留置时间及NICU治疗时间均明显长于非恩纳组 ,而镇静剂用量则显著低于后者 (P<0.01)。结论 :恩纳气管内麻醉用于神经外科围术期保留气管导管的患者安全、有效。Objective:To study the clinical application of EMLA for endotracheal anesthesia during neuroˉsurgical operation in cranial fovea posterior.Methods:The patients accepting neurosurgical operation in cranial fovea posterior(ASA I to II)were randomly divided into EMLA group(n=30)and non_EMLA group(n=30).Anesthesia was induced and maintained by propofol and fentanyl in both groups,either the records of BP,HR,SpO 2 ,T4/T1,SEF,and BIS or the physical signs were monitored during operation.The changes of tracheal mucous membrane in morphology,the complication induced by catheter and the side effect of EMLA were recorded both before and after operation.Results:The tolerances for endotracheal tube,such as BP,HR,the frequency of limb moving,etc,in EMLA group were better than those in non_EMLA group(P<0.05or P<0.01).There was no significant difference in the total retaining duration of endotracheal tube between the two groups.However,the lucid retaining duration of endotracheal tube and the treatment time in NICU in EMLA group were notably longer than those in non_EMLA group,and the dose of sedation in EMLA group was sigˉnificantly less than that in non_EMLA group(all P<0.01).Conclusion:The clinical application of EMLA for endotracheal anesthesia during neurosurgical operation in cranial fovea posterior is safe and effective.

关 键 词：恩纳 气管内麻醉 神经外科 后颅凹手术 临床应用 麻醉药 气管导管保留 

分 类 号：R651.11[医药卫生—外科学] R971.2[医药卫生—临床医学]