CAJ | 학술논문

目的验证瑞芬太尼与丙泊酚联合靶控输注用于神经外科手术静脉全麻患者时,不同手术步骤的血液动力学变化及麻醉恢复期情况和并发症.方法 5家医院230例择期行开颅手术的神经外科患者,麻醉维持分为4个阶段:术前期、开颅期、颅内期和关颅期,在不同阶段设置丙泊酚靶控输注浓度不变,而瑞芬太尼为不同血浆靶浓度,分析各步骤血液动力学的变化及麻醉恢复期情况.结果各时期瑞芬太尼血浆靶浓度分别为3.0、3.5、3.6和3.4 ng/ml.麻醉诱导神志消失时间为(2.0±0.9)min,平均动脉压(MAP)和心率(HR)均下降(P<0.05),气管插管时升高.术中血液动力学变化平稳,HR在术中各阶段均显著低于基础值(均P<0.01),麻醉恢复期MAP和HR逐渐升高,至自主呼吸恢复时升至基础水平.分别有80、41、9和12例患者术中应用尼卡地平、阿托品、艾司洛尔和麻黄碱调整血液动力学变化稳定.呼吸恢复时间(12±9)min,睁眼时间(13±7)min,拔管时间(16±8)min,定向力恢复时间(21±8)min.结论瑞芬太尼与丙泊酚联合靶控输注静脉麻醉用于神经外科手术,当丙泊酚血浆靶浓度达到3 μg/ml时,设定开颅前期、开颅期、颅内操作期和关颅期瑞芬太尼血浆靶浓度分别为3.0、3.5、3.6和3.4 ng/ml,麻醉诱导迅速、术中血流动力学平稳、麻醉恢复快,合并应用尼卡地平、阿托品等药物可以很好满足临床需要.
목적 험증서분태니여병박분연합파공수주용우신경외과수술정맥전마환자시,불동수술보취적혈액동역학변화급마취회복기정황화병발증.방법 5가의원230례택기행개로수술적신경외과환자,마취유지분위4개계단:술전기、개로기、로내기화관로기,재불동계단설치병박분파공수주농도불변,이서분태니위불동혈장파농도,분석각보취혈액동역학적변화급마취회복기정황.결과 각시기서분태니혈장파농도분별위3.0、3.5、3.6화3.4 ng/ml.마취유도신지소실시간위(2.0±0.9)min,평균동맥압(MAP)화심솔(HR)균하강(P<0.05),기관삽관시승고.술중혈액동역학변화평은,HR재술중각계단균현저저우기출치(균P<0.01),마취회복기MAP화HR축점승고,지자주호흡회복시승지기출수평.분별유80、41、9화12례환자술중응용니잡지평、아탁품、애사락이화마황감조정혈액동역학변화은정.호흡회복시간(12±9)min,정안시간(13±7)min,발관시간(16±8)min,정향력회복시간(21±8)min.결론 서분태니여병박분연합파공수주정맥마취용우신경외과수술,당병박분혈장파농도체도3 μg/ml시,설정개로전기、개로기、로내조작기화관로기서분태니혈장파농도분별위3.0、3.5、3.6화3.4 ng/ml,마취유도신속、술중혈류동역학평은、마취회복쾌,합병응용니잡지평、아탁품등약물가이흔호만족림상수요.
Objective To observe the hemodynamie changes, recovery profiles, and side effects of propofol and remifentanil anesthesia by target controlled infusion (TCI). At different neurosurgical stages in patients undergoing neurosurgieal operations. Methods 230 patients were scheduled for elective craniotomy in five hospitals in Beijing, Changsha, and Guangzhou. During the general anesthesia the plasma targetconcentration of propofol remained unchangeable and the dose of remifentanil changed at different stages before skin incision, during skull opening, during intracranial procedure, and at skull closing. The hemodynamies changes and anesthetic recovery profiles were recorded. Results The plasma targetconcentrations of remifentanil were set to 3.0, 3.5, 3.6 and 3.4 ng/ml respectively. The time of consciousness loss during induction was (2.0±0.9) min. The mean arterial pressure (MAP) and heart rate (HR) decreased after induction (both P<0.05) and increased after intubation. The hemodynamic changes were stable at different surgical stages and the HR was significantly lower than the baseline value (P<0.01). MAP and HR increased gradually when the spontaneous breathing was recovered. 80, 41,9, and 12patients received nicardipine, atropine, esmolol, and ephedrine respectively during the operation. The times of recovery of spontaneous breathing, eye opening, extubation, and orientation were (12±9) min, (13±7) min, (16±8 ) min, and (21±8 ) min respectively. Conclusion When combined with 3 μg/ml propofol, the plasma target-concentrations of remifentanil, 3.0, 3.5, 3.6, and 3.4 ng/ml before skin incision, during skull opening, during intracranial procedure, and at skull closing respectively, can provide rapid induction, faster emergence , and better hemodynamic stability.