国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2011年
5期
558-561
,共4页
经喉罩插管%经鼻气管插管%大脑皮质功能区手术%唤醒试验
經喉罩插管%經鼻氣管插管%大腦皮質功能區手術%喚醒試驗
경후조삽관%경비기관삽관%대뇌피질공능구수술%환성시험
Laryngeal mask airway%Nasotracheal intubation%Cerebral cortical functional area%Wake-up test
目的 评价经喉罩插管和经鼻气管插管两种人工气道模式对靶控输注(target controlled infusion,TCI)异丙酚-瑞芬太尼麻醉下大脑皮质功能区手术术中唤醒试验效果的影响.方法 择期行大脑皮质功能区手术的患者20例,将致病灶位于语言中枢以及同时位于语言中枢和运动中枢的患者称为喉罩组(Ⅰ组),将致病灶位于运动中枢的患者称为气管插管组(Ⅱ组).两组患者的麻醉诱导均采用异丙酚-瑞芬太尼TCI,Ⅰ组至意识消失后行喉罩插管,Ⅱ组待患者进入深睡眠状态后,经鼻气管插管,两组患者的麻醉维持均采用异丙酚-瑞芬太尼TCI,按相同的脑电双频指数(BIS)值来调整血药靶浓度.术中行唤醒试验,记录唤醒时间.记录麻醉诱导即刻(T1)、插管后10 min(T2)、患者能按指令活动时(T3)的平均动脉压(MAP)、心率(HR)、呼气末二氧化碳分压(PETCO2)的变化,同时记录两组患者唤醒期间的相关并发症.结果 所有患者均完成唤醒试验,唤醒时间分别为(16.9±2.4)min(Ⅰ组)、(15.7±1.8)min(Ⅱ组),两组患者唤醒时间差异无统计学意义(P＞0.05)；唤醒期间Ⅱ组恶心、呕吐,高碳酸血症,脑膨胀的发生率(0％)显著低于Ⅰ组(20％)(P＜0.05).结论 对病灶位于大脑皮质运动中枢的患者,尽量使用TCI异丙酚-瑞芬太尼麻醉下经鼻气管插管的人工通气模式,可以提高术中唤醒试验的效果.
目的 評價經喉罩插管和經鼻氣管插管兩種人工氣道模式對靶控輸註(target controlled infusion,TCI)異丙酚-瑞芬太尼痳醉下大腦皮質功能區手術術中喚醒試驗效果的影響.方法 擇期行大腦皮質功能區手術的患者20例,將緻病竈位于語言中樞以及同時位于語言中樞和運動中樞的患者稱為喉罩組(Ⅰ組),將緻病竈位于運動中樞的患者稱為氣管插管組(Ⅱ組).兩組患者的痳醉誘導均採用異丙酚-瑞芬太尼TCI,Ⅰ組至意識消失後行喉罩插管,Ⅱ組待患者進入深睡眠狀態後,經鼻氣管插管,兩組患者的痳醉維持均採用異丙酚-瑞芬太尼TCI,按相同的腦電雙頻指數(BIS)值來調整血藥靶濃度.術中行喚醒試驗,記錄喚醒時間.記錄痳醉誘導即刻(T1)、插管後10 min(T2)、患者能按指令活動時(T3)的平均動脈壓(MAP)、心率(HR)、呼氣末二氧化碳分壓(PETCO2)的變化,同時記錄兩組患者喚醒期間的相關併髮癥.結果 所有患者均完成喚醒試驗,喚醒時間分彆為(16.9±2.4)min(Ⅰ組)、(15.7±1.8)min(Ⅱ組),兩組患者喚醒時間差異無統計學意義(P＞0.05)；喚醒期間Ⅱ組噁心、嘔吐,高碳痠血癥,腦膨脹的髮生率(0％)顯著低于Ⅰ組(20％)(P＜0.05).結論 對病竈位于大腦皮質運動中樞的患者,儘量使用TCI異丙酚-瑞芬太尼痳醉下經鼻氣管插管的人工通氣模式,可以提高術中喚醒試驗的效果.
목적 평개경후조삽관화경비기관삽관량충인공기도모식대파공수주(target controlled infusion,TCI)이병분-서분태니마취하대뇌피질공능구수술술중환성시험효과적영향.방법 택기행대뇌피질공능구수술적환자20례,장치병조위우어언중추이급동시위우어언중추화운동중추적환자칭위후조조(Ⅰ조),장치병조위우운동중추적환자칭위기관삽관조(Ⅱ조).량조환자적마취유도균채용이병분-서분태니TCI,Ⅰ조지의식소실후행후조삽관,Ⅱ조대환자진입심수면상태후,경비기관삽관,량조환자적마취유지균채용이병분-서분태니TCI,안상동적뇌전쌍빈지수(BIS)치래조정혈약파농도.술중행환성시험,기록환성시간.기록마취유도즉각(T1)、삽관후10 min(T2)、환자능안지령활동시(T3)적평균동맥압(MAP)、심솔(HR)、호기말이양화탄분압(PETCO2)적변화,동시기록량조환자환성기간적상관병발증.결과 소유환자균완성환성시험,환성시간분별위(16.9±2.4)min(Ⅰ조)、(15.7±1.8)min(Ⅱ조),량조환자환성시간차이무통계학의의(P＞0.05)；환성기간Ⅱ조악심、구토,고탄산혈증,뇌팽창적발생솔(0％)현저저우Ⅰ조(20％)(P＜0.05).결론 대병조위우대뇌피질운동중추적환자,진량사용TCI이병분-서분태니마취하경비기관삽관적인공통기모식,가이제고술중환성시험적효과.
Objective To investigate the effect of laryngeal mask airway(LMA)and transnasal tracheal intubation airway on intraoperative wake-up test in patients during operation on cerebral cortical functional area under propofol-remifentanil anesthesia administered by target controlled infusion(TCI).Methods Twenty ASA Ⅰ-Ⅱ patients undergoing neurosurgery on cerebral cortical functional area were divided into two groups(n=10)by different surgery sites:Group Ⅰ-in the language centre or/and motive centre,Group Ⅱ-in the motive centre.TCI technique was used in induction and maintenance during propofol-remifentanil anesthesia in two both groups.Under deep sedation,an LMA was insetted in group Ⅰ,whereas nasotracheal intubation in group Ⅱ.We carried on wake-up test during the operation,and defined the wake-up time as the duration from interruption of anesthesia to the moment patients responded to commands,and recorded the variables of mean arterial pressure(MAP),heart rate(HR),and end tidal carbon dioxide(PETCO2)at different time-point including anesthesia induction(T1),10 min after intubation(T2)and wake-up time(T3),the corresponding target plasma concentration of propofol and remifentanil and adverse events during wake-up test were also recorded simultaneously.Results All patients completed wake-up test during operation successfully.The wake-up time was(16.9±2.4)min and(15.7±1.8)min in group Ⅰ and Ⅱ respectively,without reaching significant change in both groups(P＞O.05).But during intraoperative wake-up test,the incidence of vomiting,hypercapnia and brain swelling were significantly lower in group Ⅱ(0％)than in group Ⅰ(20％)(P＜0.05).Conclusion Compared with LMA,nasotracheal intubation airway can increase the effect of wake-up test while using TCI technique with propofol-remifentail anesthesia in patients underwent operations in the site of cerebral cortical motive centre.
