快通道麻醉在颅内动脉瘤栓塞术的应用(1)
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【摘要】 目的 对比研究喉罩通气和气管插管复合瑞芬太尼、丙泊酚全凭静脉麻醉在颅内动脉瘤栓塞术的应用。方法 48例经DSA行颅内动脉瘤栓塞术的患者随机分为喉罩组(L组)和气管插管组(T组),术中以微量泵持续泵注丙泊酚、瑞芬太尼维持麻醉,记录在麻醉诱导前、插入喉罩或气管插管时、插入后、动脉瘤栓塞及拔除喉罩或气管插管时、拔除后5 min的平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)、气道峰压(Pmax)、气道平均压(Pmean)、呼气末二氧化碳分压(PETCO2)的变化,观察术毕患者自主呼吸恢复时间、睁眼时间、拔管时间以及拔除时患者是否呛咳、躁动、恶心呕吐。结果 喉罩组(L组)麻醉诱导、术中维持及术后苏醒血液动力学平稳,苏醒迅速,并发症发生率低。结论 喉罩复合瑞芬太尼丙泊酚全凭静脉麻醉应用于颅内动脉瘤栓塞术安全、可行。
【关键词】 喉罩;瑞芬太尼;丙泊酚;颅内动脉瘤栓塞术;快通道麻醉
The application of the fast-track anaesthesia in intracranial aneurysm
ZHAN Yu-ru,ZHANG Wen-hua,ZHANG Jun-ting,et al.Department of Aneasthesiology,The third Hospital,Qiqihaer College,Qiqihaer 161000,China
【Abstract】 Objective To compare the use of laryngeal mask with endotracheal intubation combination remifentaniland propofol in intracranial aneurysm.Methods Fourty-eight patients scheduled for intracranial aneurysm were divided randomlyinto two groups.The patients were inserted laryngeal mask or intubation after intravenous induction and received infusion propofol and remifentanil.Hemodynamic paraments were continuously monitored.The time of recovery breath,extradule,awaken were recorded.Whether coughing,restlessness and nausea and vomiting when extradule intubation were also recorded.Results The patients that insert laryngeal combination propofol with remifentanil were stable during induction,operation and recovery.Hemodynamic parameters were more stable,awake were more rapid.Conclusion Laryngeal mask with propofol andremifentanil is more suitable for intracranial aneurysm.
【Key words】Laryngeal mask; Remifentaniland propofol; Intracranial aneurysm fast-track anaesthesia
作者单位:161000齐齐哈尔医学院附属第三医院
颅内动脉瘤栓塞术是一种有效治疗颅内动脉瘤的方法,其损伤小,预后佳,已被广大患者所接受。喉罩是一种新的无创通气模式,具有对咽喉部刺激小,通气效果好,手术并发症少等特点[1]。本研究探讨喉罩通气复合瑞芬太尼丙泊酚全凭静脉麻醉,用于颅内动脉瘤栓塞术的麻醉效果和安全性。
1 资料与方法
1.1 一般资料 选择ASAⅠ~Ⅱ级择期行颅内动脉瘤栓塞术的患者48例,男26例,女22例,年龄41~65岁,体重48~79 kg。患者术前无意识障碍,无严重高血压、冠心病病史及严重肝肾功能障碍,随机分为喉罩组(L组)和气管插管组(T组),每组各24例。
1.2 麻醉方法 麻醉诱导为咪达唑仑0.05 mg/kg,芬太尼3 μg/kg,丙泊酚1.5~2 mg/kg,待患者意识消失后给予维库溴铵0.1 mg/kg,肌松后行喉罩或气管插管置入,再用纤维支气管镜观察确定喉罩已正确置入,接呼吸机行间歇机械正压通气(IPPV),潮气量10 ml/kg,呼吸频率12次/min,呼吸比1:2。微量泵持续泵注丙泊酚6 mg/(kg•h),瑞芬太尼0.1 μg/kg/min维持麻醉,脑电双频指数(BIS)控制在40~60之间,并适当调整麻醉用药量 ......
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