CAJ | 학술논문

目的探讨雷米芬太尼在清醒状态下切除脑功能区肿瘤的临床应用.方法 24例脑功能区肿瘤患者,ASA分级Ⅱ～Ⅲ级;采用机械抽样法随机分为对照组和雷米芬太尼组,每组12例.全部患者以0.2%罗哌卡因沿切口行局部浸润麻醉.雷米芬太尼组术中以微量泵持续静脉注射雷米芬太尼0.05～0.10μg/(kg·min),根据手术需要作适当调整;对照组术中以0.9%氯化钠代替雷米芬太尼.两组均保持术中患者意识清醒,监测术中血流动力学变化和并发症情况,记录术后患者对手术过程的满意度.结果两组患者均能在清醒状态下配合完成手术,雷米芬太尼组的平均动脉压和心率在开颅、颅内手术期、关颅时点均明显低于对照组(P<0.05),未见明显呼吸抑制、恶心呕吐、烦躁不安等并发症,雷米芬太尼组术后满意度评分为(3.3±0.6)分,明显高于对照组的(2.4±0.5)分,差异有统计学意义(p<0.05).结论在局部麻醉切除脑功能区肿瘤时合理应用雷米芬太尼,可使患者血流动力学稳定,且手术耐受性良好.
목적 탐토뢰미분태니재청성상태하절제뇌공능구종류적림상응용.방법 24례뇌공능구종류환자,ASA분급Ⅱ～Ⅲ급;채용궤계추양법수궤분위대조조화뢰미분태니조,매조12례.전부환자이0.2%라고잡인연절구행국부침윤마취.뢰미분태니조술중이미량빙지속정맥주사뢰미분태니0.05～0.10μg/(kg·min),근거수술수요작괄당조정;대조조술중이0.9%록화납대체뢰미분태니.량조균보지술중환자의식청성,감측술중혈류동역학변화화병발증정황,기록술후환자대수술과정적만의도.결과 량조환자균능재청성상태하배합완성수술,뢰미분태니조적평균동맥압화심솔재개로、로내수술기、관로시점균명현저우대조조(P<0.05),미견명현호흡억제、악심구토、번조불안등병발증,뢰미분태니조술후만의도평분위(3.3±0.6)분,명현고우대조조적(2.4±0.5)분,차이유통계학의의(p<0.05).결론 재국부마취절제뇌공능구종류시합리응용뢰미분태니,가사환자혈류동역학은정,차수술내수성량호.
Objective To investigate the clinical application of remifentanil in awake state for removal of tumors in functional brain area. Methods Twenty-four patients with tumors in functional brain area were divided into two groups by random digits table with 12 cases each:control group and remifentanil group. Infiltration anesthesia was used in all patients with 0.2% ropivacaine. Remifentanil was injected intravenously with micropump in 0.05-0.10 μg/ (kg·min) in remifentanil group and 0.9% sodium chloride was instead of remifentanil in control group. Patients remained awake during surgery in both groups. The hemodynamic changes and complications during operation were monitored. The satisfaction for surgical procedure was evaluated. Results The patients in two groups could be completed in awake state with surgery;mean artery pressure, heart rate in remifentanil group during opening or closing skull or intracranial period were significantly higher than those in control group(P< 0.05). There were no conspicuous complication in two groups such as respiratory depression, nausea, vomitting and dysphoria. The satisfaction score in remifentanil group[(3.3 ?0.6) scores] was higher than that in control group[(2.4 ?0.5) scores],there was significant difference between two groups (P<0.05). Conclusion Awake brain tumor surgery could be completed in rational use of remifentanil on the base of good local anesthesia, and hemodynamics are stable and the patients are well tolerated.