中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
35期
5-7
,共3页
麻醉,全身%颅脑手术%保留呼吸
痳醉,全身%顱腦手術%保留呼吸
마취,전신%로뇌수술%보류호흡
Anesthesia,general%Craniocerebral operation%Keep respiration
目的 探讨保留呼吸气管插管全身麻醉在颅脑手术中的麻醉效果及安全性.方法 选择行颅脑手术患者86例,按随机数字表法分为常规麻醉组和保留呼吸麻醉组,每组43例.常规麻醉组采用常规诱导气管插管,给药次序为咪达唑仑0.05 mg/kg、芬太尼2~4μg/kg、顺阿曲库铵0.2~0.3 mg/kg、丙泊酚1.0~ 1.5 mg/kg;保留呼吸麻醉组患者采用快速诱导气管插管,给药次序为咪达唑仑0.05 mg/kg、芬太尼2~4 ~g/kg、丙泊酚1.0~ 1.5 mg/kg、氯化琥珀胆碱1.5 mg/kg;两组插管完成后接Ohmeda 7100型麻醉机控制呼吸,微量泵持续输注丙泊酚及瑞芬太尼,并吸入异氟烷维持麻醉;常规麻醉组间断静脉注射顺阿曲库铵;保留呼吸麻醉组在氯化琥珀胆碱作用消失后改用自主呼吸,根据呼吸次数调节瑞芬太尼输注速度,使呼吸次数保持在8~12次/min,记录两组术中丙泊酚、瑞芬太尼用量,追加芬太尼次数,术中气道压和呼气末二氧化碳分压(PETCO2),术中患者体动情况,拔管时间,拔管后15 min警觉/镇静评分及不良反应.结果 两组手术时间、术中体动次数、术中气道压及PETCO2比较差异无统计学意义(P>0.05).保留呼吸麻醉组术中丙泊酚、瑞芬太尼用量及追加芬太尼次数较常规麻醉组高[(69.2±13.7)μg/ (kg·min)比(61.0±8.2) μg/ (kg· min)、(0.19±0.06)μg/(kg·min)比(0.15±0.05)μg/(kg· min)、1.5次比0次],差异有统计学意义(P<0.05).保留呼吸麻醉组拔管时间明显短于常规麻醉组[(6.4±3.2) min比(11.3±4.5) min],拔管后15 min警觉/镇静评分明显低于常规麻醉组[1(1 ~3)分比2(1 ~3)分],差异均有统计学意义(P<0.05).结论 保留呼吸气管插管全身麻醉下行颅脑手术患者呼吸恢复早,拔管时间明显缩短,是一种安全高效的麻醉方法.
目的 探討保留呼吸氣管插管全身痳醉在顱腦手術中的痳醉效果及安全性.方法 選擇行顱腦手術患者86例,按隨機數字錶法分為常規痳醉組和保留呼吸痳醉組,每組43例.常規痳醉組採用常規誘導氣管插管,給藥次序為咪達唑崙0.05 mg/kg、芬太尼2~4μg/kg、順阿麯庫銨0.2~0.3 mg/kg、丙泊酚1.0~ 1.5 mg/kg;保留呼吸痳醉組患者採用快速誘導氣管插管,給藥次序為咪達唑崙0.05 mg/kg、芬太尼2~4 ~g/kg、丙泊酚1.0~ 1.5 mg/kg、氯化琥珀膽堿1.5 mg/kg;兩組插管完成後接Ohmeda 7100型痳醉機控製呼吸,微量泵持續輸註丙泊酚及瑞芬太尼,併吸入異氟烷維持痳醉;常規痳醉組間斷靜脈註射順阿麯庫銨;保留呼吸痳醉組在氯化琥珀膽堿作用消失後改用自主呼吸,根據呼吸次數調節瑞芬太尼輸註速度,使呼吸次數保持在8~12次/min,記錄兩組術中丙泊酚、瑞芬太尼用量,追加芬太尼次數,術中氣道壓和呼氣末二氧化碳分壓(PETCO2),術中患者體動情況,拔管時間,拔管後15 min警覺/鎮靜評分及不良反應.結果 兩組手術時間、術中體動次數、術中氣道壓及PETCO2比較差異無統計學意義(P>0.05).保留呼吸痳醉組術中丙泊酚、瑞芬太尼用量及追加芬太尼次數較常規痳醉組高[(69.2±13.7)μg/ (kg·min)比(61.0±8.2) μg/ (kg· min)、(0.19±0.06)μg/(kg·min)比(0.15±0.05)μg/(kg· min)、1.5次比0次],差異有統計學意義(P<0.05).保留呼吸痳醉組拔管時間明顯短于常規痳醉組[(6.4±3.2) min比(11.3±4.5) min],拔管後15 min警覺/鎮靜評分明顯低于常規痳醉組[1(1 ~3)分比2(1 ~3)分],差異均有統計學意義(P<0.05).結論 保留呼吸氣管插管全身痳醉下行顱腦手術患者呼吸恢複早,拔管時間明顯縮短,是一種安全高效的痳醉方法.
목적 탐토보류호흡기관삽관전신마취재로뇌수술중적마취효과급안전성.방법 선택행로뇌수술환자86례,안수궤수자표법분위상규마취조화보류호흡마취조,매조43례.상규마취조채용상규유도기관삽관,급약차서위미체서륜0.05 mg/kg、분태니2~4μg/kg、순아곡고안0.2~0.3 mg/kg、병박분1.0~ 1.5 mg/kg;보류호흡마취조환자채용쾌속유도기관삽관,급약차서위미체서륜0.05 mg/kg、분태니2~4 ~g/kg、병박분1.0~ 1.5 mg/kg、록화호박담감1.5 mg/kg;량조삽관완성후접Ohmeda 7100형마취궤공제호흡,미량빙지속수주병박분급서분태니,병흡입이불완유지마취;상규마취조간단정맥주사순아곡고안;보류호흡마취조재록화호박담감작용소실후개용자주호흡,근거호흡차수조절서분태니수주속도,사호흡차수보지재8~12차/min,기록량조술중병박분、서분태니용량,추가분태니차수,술중기도압화호기말이양화탄분압(PETCO2),술중환자체동정황,발관시간,발관후15 min경각/진정평분급불량반응.결과 량조수술시간、술중체동차수、술중기도압급PETCO2비교차이무통계학의의(P>0.05).보류호흡마취조술중병박분、서분태니용량급추가분태니차수교상규마취조고[(69.2±13.7)μg/ (kg·min)비(61.0±8.2) μg/ (kg· min)、(0.19±0.06)μg/(kg·min)비(0.15±0.05)μg/(kg· min)、1.5차비0차],차이유통계학의의(P<0.05).보류호흡마취조발관시간명현단우상규마취조[(6.4±3.2) min비(11.3±4.5) min],발관후15 min경각/진정평분명현저우상규마취조[1(1 ~3)분비2(1 ~3)분],차이균유통계학의의(P<0.05).결론 보류호흡기관삽관전신마취하행로뇌수술환자호흡회복조,발관시간명현축단,시일충안전고효적마취방법.
Objective To study the effect and safety on the retention respiratory inhalation general anesthesia in craniocerebral operation.Methods Eighty-six patients undergoing craniocerebral operation were divided into conventional anesthesia group (group A) and retention respiratory anesthesia group (group B) by random digits table method with 43 cases each.Group A was given conventional induction and intubation,administration order:midazolam 0.05 mg/kg,fentanyl 2-4 μ g/kg,cisatracurium 0.2-0.3 mg/kg,propofol 1.0-1.5 mg/kg;group B was given rapid induction and intubation,administration order:midazolam 0.05 mg/kg,fentanyl 2-4 μg/kg,propofol 1.0-1.5 mg/kg,succinylcholine 1.5 mg/kg.The 2 groups after intubation done by Ohmeda 7100 anesthesia machine control respiration,trace pump continuous infusion of propofol and remifentanil,and maintained inhaling isoflurane anesthesia.Group A was discontinuity intravenous injection atracurium.Group B was changed autonomous breathing after the succinylcholine effect disappeared,respiratory frequency according to the regulation of remifentanil infusion rate,the respiration rate remained at 8-12 times/min.The consumption of propofol and remifentanil,additional times of fentanyl,intraoperative airway pressure,partial pressure of carbon dioxide in end expiratory gas (PE TCO2),intraoperative body movement,airway pressure,extubation time,OAA/S score after extubation 15 min and untoward reaction were recorded.Results There were no statistical differences in operation time,intraoperative body movement,intraoperative airway pressure and PETCO2 between the 2 groups (P> 0.05).The consumption of propofol and remifentanil,additional times of fentanyl in group B were significantly higher than those in group A [(69.2 ± 13.7) μg/(kg·min) vs.(61.0 ± 8.2)μg/(kg·min),(0.19 ± 0.06) μ g/ (kg· min) vs.(0.15 ± 0.05) μ g/ (kg· min),1.5 times vs.0 time],there were statistical differences (P< 0.05).The extubation time in group B was significantly shorter than that in group A [(6.4 ±3.2) min vs.(11.3 ± 4.5) min],the OAA/S score after extubation 15 min in group B was significantly lower than that in group A [1 (1-3) scores vs.2(1-3) scores],there were statistical differences between the 2 groups (P < 0.05).Conclusion Retention respiration intubation general anesthesia patients of craniocerebral operation can early recover,extubation time is significantly shorter,it is a safe and effective anesthesia method.