CAJ | 학술논문

目的：对比丙泊酚复合瑞芬太尼全凭静脉麻醉和七氟醚复合瑞芬太尼静脉吸入复合麻醉在神经外科手术中的麻醉效果。方法选择本院2014年3~10月择期神经外科手术全麻患者40例，ASAⅠ~Ⅱ级，将其随机分为丙泊酚-瑞芬太尼组（P组，n=20）和七氟醚-瑞芬太尼组（S组，n=20），麻醉诱导均采用咪达唑仑、芬太尼、顺苯磺酸阿曲库胺、丙泊酚。常规气管插管后行机械通气，瑞芬太尼持续静脉输注维持术中镇痛，P组和S组患者分别采用丙泊酚持续静脉输注和七氟烷持续吸入维持麻醉深度，手术结束后停止麻醉药。分别于麻醉后不同时间点[麻醉诱导后（T1）、切皮（T2）、切开硬脑膜（T3）、颅内占位切除约一半（T4）、关闭硬脑膜（T5）、缝皮结束（T6）]测定患者的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）及心率（HR），观察手术结束后患者的麻醉苏醒时间、拔管时间、不良反应情况。结果 S组的麻醉苏醒时间、拔管时间均明显长于P组（P<0.05）；麻醉后不同时间点两组患者的血流动力学指标及拔管后不良反应发生率差异无统计学意义（P>0.05）。结论丙泊酚和七氟醚均适用于神经外科手术麻醉维持，而丙泊酚复合瑞芬太尼的全凭静脉麻醉苏醒更加迅速。
목적：대비병박분복합서분태니전빙정맥마취화칠불미복합서분태니정맥흡입복합마취재신경외과수술중적마취효과。방법선택본원2014년3~10월택기신경외과수술전마환자40례，ASAⅠ~Ⅱ급，장기수궤분위병박분-서분태니조（P조，n=20）화칠불미-서분태니조（S조，n=20），마취유도균채용미체서륜、분태니、순분광산아곡고알、병박분。상규기관삽관후행궤계통기，서분태니지속정맥수주유지술중진통，P조화S조환자분별채용병박분지속정맥수주화칠불완지속흡입유지마취심도，수술결속후정지마취약。분별우마취후불동시간점[마취유도후（T1）、절피（T2）、절개경뇌막（T3）、로내점위절제약일반（T4）、관폐경뇌막（T5）、봉피결속（T6）]측정환자적수축압（SBP）、서장압（DBP）、평균동맥압（MAP）급심솔（HR），관찰수술결속후환자적마취소성시간、발관시간、불량반응정황。결과 S조적마취소성시간、발관시간균명현장우P조（P<0.05）；마취후불동시간점량조환자적혈류동역학지표급발관후불량반응발생솔차이무통계학의의（P>0.05）。결론병박분화칠불미균괄용우신경외과수술마취유지，이병박분복합서분태니적전빙정맥마취소성경가신속。
Objective To evaluate the anaesthetic effectiveness in neurosurgery between the remifentanil combined with propofol infusion in total intravenous anesthesia and the sevoflurane combined with remifentanil intravenous inhalation anesthesia. Methods 40 patients with ASA Ⅰ-II,scheduled for neurosurgery operation in our hospital from March to October 2014 were selected,and were randomly divided into propofol-remifentanil group (group P) and sevoflurane-remifentanil group (group S),20 cases in each group.Midazolam,fentanyl,cis-atracurium,and propofol were used in the induction of anesthesia.The mechanical ventilatione were applied after conventional trachea cannula.Then remifentanil were infused consistently by venous to malntaln intraoperative analgesia.While patients in group S were received sevoflurane instead,patients in group P were received propofol by continuous intravenous infusion for depth of anesthe-sia until the operation finished.Once patients were anesthetized steadily,systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP) and heart rate (HR) at different time [after anesthesia induction (T1),cut the skin (T2),incision (T3),intracranial dural placeholder to remove about half (T4),close the dura (T5),sewing leather end (T6)] was collected.When operation completed,Anesthesia waking time,extubation time,adverse reactions was observed. Results The recovery time and extubation time in group S was longer than that in group P (P<0.05).But the hemody-namic indexes and the adverse reaction after extubation had no significant difference (P>0.05). Conclusion Propofol and sevoflurane are suitable to anesthetic malntenance in neurosurgery,but patients who underwent the remifentanil combined with infusion in total intravenous anesthesia wake more quickly.