CAJ | 학술논문

目的探讨比较无肌松剂辅助下七氟烷复合瑞芬太尼和丙泊酚复合瑞芬太尼这两种麻醉方法用于听神经瘤切除术时面神经监测的效果及安全性. 方法广东三九脑科医院麻醉科自2011年10月至2012年12月在无肌松剂辅助全麻下行听神经瘤切除加面神经监测63例,其中应用七氟烷复合瑞芬太尼麻醉32例,丙泊酚复合瑞芬太尼麻醉31例.比较2组患者入室(T0)、切皮(T1)、探查面神经走行(T2)、处理脑干面肿瘤(T3)、术毕(T4)时平均动脉压(MAP)、心率(HR)、体动及面神经监测情况. 结果丙泊酚复合瑞芬太尼组患者术中MAP、HR平稳,各时间点间比较差异无统计学意义(P＞0.05).而与丙泊酚复合瑞芬太尼组相同时间点比较,七氟烷复合瑞芬太尼组患者T2、T3时MAP较高、HR较低,差异均有统计学意义(P＜0.05).2组患者均无明显体动并收集到有意义的自发肌电信号,监测成功率100％. 结论无肌松剂辅助下七氟烷复合瑞芬太尼和丙泊酚复合瑞芬太尼这两种麻醉方法均能满足听神经瘤切除术中面神经监测要求,麻醉效果亦可满足手术要求,其中丙泊酚复合瑞芬太尼能更好地维持血流动力学平稳.
목적 탐토비교무기송제보조하칠불완복합서분태니화병박분복합서분태니저량충마취방법용우은신경류절제술시면신경감측적효과급안전성. 방법 엄동삼구뇌과의원마취과자2011년10월지2012년12월재무기송제보조전마하행은신경류절제가면신경감측63례,기중응용칠불완복합서분태니마취32례,병박분복합서분태니마취31례.비교2조환자입실(T0)、절피(T1)、탐사면신경주행(T2)、처리뇌간면종류(T3)、술필(T4)시평균동맥압(MAP)、심솔(HR)、체동급면신경감측정황. 결과 병박분복합서분태니조환자술중MAP、HR평은,각시간점간비교차이무통계학의의(P＞0.05).이여병박분복합서분태니조상동시간점비교,칠불완복합서분태니조환자T2、T3시MAP교고、HR교저,차이균유통계학의의(P＜0.05).2조환자균무명현체동병수집도유의의적자발기전신호,감측성공솔100％. 결론 무기송제보조하칠불완복합서분태니화병박분복합서분태니저량충마취방법균능만족은신경류절제술중면신경감측요구,마취효과역가만족수술요구,기중병박분복합서분태니능경호지유지혈류동역학평은.
Objective To investigate the feasibility and differences of two anesthetic methods (sevoflurane combined with remifentanil and propofol combined with remifentanil) in facial nerve monitoring without muscle relaxant during resection of acoustic neuromas.Methods Sixty-three patients with acoustic neuromas,admitted to our hospital from October 2011 to December 2012 and performed intraoperative monitoring of facial nerve without muscle relaxant assisted anesthesia,were collected in our study,and they were divided into two groups:sevoflurane combined with remifentanil treatment group (group S,n=32) and propofol combined with remifentanil treatment group (group P,n=31).The mean arterial pressure (MAP),heart rate (HR),intraoperative body movement and facial nerve were monitored and compared during the home invasion (T0),cuttng skin (T1),exploration of the facial nerve (T2),treatment of tumor near the brainstem (T3) and finishing of operation (T4).Results The MAP and HR were stable during the operation in patients of group P,without significant difference between each two observation time points (P＞0.05).Higher MAP and lower HR in the patients of group S at T2 and T3 were noted as compared with those in patients of group S at T0 and patients of group P at each same time point (P＜0.05).Facial nerve monitoring was completely possible and the anesthesia was effective in two groups.No obvious body movement was noted during the operation.Conclusion Two methods (sevoflurane combined with remifentanil and propofol combined with remifentanil) in facial nerve monitoring without muscle relaxant during resection of acoustic neuromas are completely possible and effective,and the latter one provides better hemodynamics.