摘要
目的比较Narcotrend监测下靶控输注舒芬太尼或瑞芬太尼复合异丙酚在脑功能区唤醒麻醉中的效果。方法选择脑功能区手术病人40例,随机分为舒芬太尼(sufentanil,SF)组和瑞芬太尼(remifentanil,RF)组,每组20例。两组分别使用异丙酚复合SF或RF靶控输注诱导,插入喉罩行机械通气,在切口浸润麻醉和硬脑膜表面麻醉下,减少药物浓度使病人在功能定位和切除肿瘤过程中保持清醒。比较两组病人的血流动力学变化、Narcotrend监测下唤醒时间、唤醒质量,通过镇静评分(OAA/S)和视觉模拟评分法(VAS)评价两组是否能够提供合适的镇静和镇痛。结果两组均能在较短时间内唤醒病人,差异无统计学意义(P>0.05)。插喉罩时,SF组的平均动脉压(MAP)高于RF组(P<0.05)。在唤醒时,RF组心率和MAP明显高于基础值(P<0.05),SF组心率高于基础值(P<0.05),MAP稍低于基础值。苏醒后,SF组血压低于RF组(P<0.05)。两组唤醒后的OAA/S评分无统计学差异(P>0.05),SF组唤醒后5min、10min、30min的VAS评分明显小于RF组(P<0.05)。结论SF或RF联合异丙酚均能很好地应用于脑功能区唤醒手术,SF在病人苏醒后能提供更好的镇痛作用,且不延长病人苏醒时间,在苏醒后血流动力学稳定性方面更具有优势。
Objective To compare the efficacy ofpropofol combined with sufentanil and remifentanil in awake anesthesia under Narcotrend monitoring. Methods Forty patients undergoing eloquent area operation with intraoperative awakening were randomly divided into two groups： propofol ＋ sufentanil group （SF group） and propofol ＋ remifentanil group （RF group）, 20 each. Patients were anaesthetized by propofol ＋ sufentanil or propofol ＋ remifentanil respectively, the laryngeal mask was used for mechanical ventilation. Concentrations of the drugs above were reduced under incision infiltration anesthesia and cerebral dura mater topical anesthesia to keep the patient＇s awake during brain mapping and tumor resection. Changes of hemodynamics, awakening time and awaking quality under the Nareotrend monitoring were compared between the two groups. The degrees of sedation and analgesia were evaluated through assessment of alertness and sedation scores （OAA/S） and visual analog scale scores （VAS）. Results All patients can be aroused in a short time, however, no statistical differences was found between the two groups （P 〉 0.05）. The mean arterial blood pressure （MAP） in SF group was significantly higher than RF group when the laryngeal mask was inserted （P 〈 0.05）. During awake period, the heart rate （HR） and MAP in SF group were significantly lower than RF group （P 〈 0.05）, the HR in SF group was higher than the basic value （P 〈 0.05） but the MAP was a little lower than the basic value. The MAP in SF group was lower than RF group after the patients awaked （P 〈 0.05）. The OAA/S has no statistical differences between SF group and RF group （P〉 0.05）. The VAS was significantly lower in SF group than in RF group after the patients were awakened for 5, 10 and 30 minutes （P 〈 0.05）. Conclusion Propofol combined with sufentanil or remifentanil all can be well applied for awake surgery. However, sufentanil have more advantages, such as better analgesia, more stable hemodynamics and shorter awakening time.
出处
《中国微侵袭神经外科杂志》
CAS
北大核心
2009年第12期539-542,共4页
Chinese Journal of Minimally Invasive Neurosurgery
