【摘要】 目的:比较瑞芬太尼和异丙酚靶控输注麻醉与异氟烷静吸复合麻醉对脑肿瘤患者术中脑氧代谢的影响。方法:择期颅内肿瘤手术患者36例,ASAⅠ~Ⅱ级,随机分为静吸复合组(C组)15例和瑞芬太尼靶控输注组(R组)21例。R组:诱导时设定异丙酚血浆靶浓度3μg/ml,瑞芬太尼血浆靶浓度6 ng/ml,术中根据刺激的强弱、心率和血压的变化调整血浆靶控输注的浓度。C组:异丙酚2 mg/kg、芬太尼2μg/kg和维库溴铵0.1 mg/kg诱导插管,术中吸入1%~2%异氟醚,间断静注维库溴铵维持麻醉。两组患者均连续监测有创血压(MAP)、心率(HR)、心电图(ECG)和脉搏氧饱和度(SpO2)、呼末二氧化碳(PETCO2)。记录诱导前(T1)、插管即刻(T2)、插管后5 min(T3)、切开硬膜(T4)、取瘤30 min(T5)、术毕(T6)、清醒拔管时(T7)7个时点BP、HR、SpO2、PETCO2及苏醒时间。于麻醉诱导前(t1)、诱导后30 min(t2)、麻醉后1 h(t3)、2 h(t4)、清醒拔管时(t5)采集动静脉血进行血气分析,分别测定颈内静脉氧饱和度(SjvO2)及动静脉氧差(Da-jvO2)。结果:T1~T7各时点BP、HR、SpO2和PETCO2两组之间差异均无统计学意义(P>0.05);C组和R组患者T2时MAP分别低于T1时(P<0.05)。C组患者苏醒时间长于R组(P<0.05)。t2~t4时间点C组SjvO2均高于R组,而Da-jvO2均低于R组(P<0.05)。C组SjvO2t2~t4时间点均高于同组t1时,而C组Da-jvO2t2~t4时间点均高于同组t1时(P<0.05)。结论:瑞芬太尼和异丙酚靶控输注与异氟烷静吸复合麻醉用于脑肿瘤患者的手术,均可维持患者平稳的生命体征,靶控输注麻醉患者术毕清醒更迅速,且比静吸复合麻醉能更好的维持脑氧供需平衡。更多还原

【Abstract】 Objective: To explore the effects of remifentanil and propofol TCI anesthesia on cerebral oxygen metabolism in surgery of brain tumor patients with isoflurane balanced anesthesia.Methods: 36 ASA Ⅰto Ⅱelective intra-cranial tumor patients were randomly divided into the isoflurane balanced anesthesia group(C group)(n=15) and the TCI group(R group)(n=21).Patients in the R group were inducted by propofol TCI with plasma concentration 3 μg/ml and remifentanil TCI with plasma concentration 6 ng/ml and they were maintained with remifentanil and propofol TCI anesthesia.The plasma concentrations were determined based on the stimulus and patients′ response in the surgeryprocedure.Patients in the C group were inducted by propofol 2 mg/kg,fentanyl 0.2 μg/kg and vecuronium 0.1 mg/kg-1.After intubation,1% to 2% isoflurane and vecuronium were administered based on the stimulus and patients′ response in the surgery procedure.The BP,HR,SpO2 and PETCO2 were determined at pre-induction(T1),intubation(T2), 5 min after intubation(T3),slicing the duramater(T4),30 min after removing the tumor(T5),the end of the operation(T6)and extubation(T7) and the recover time was also determined.Meanwhile the SjvO2 and Da-jvO2 were determined at pre-induction(t1),30 min after induction(t2),1 h after induction(t3),2 h after induction(t4),and extubation(t5).Results: Patients′ BP,HR,SpO2 and PETCO2 were similar between the two groups(P>0.05).In both groups,patients′ BP significantly decreased after induction(P<0.05).Patients in the C group recovered more slowly than those in the R group(P<0.05).SjvO2 of the C group was higher than that of the R group,while Ca-jvDO2 of the C group was lower than that of the R group at time of t2,t3 and t4(P<0.05).SjvO2 at t2,t3 and t4 was higher than that at t1,while Da-jvO2 at t2,t3 and t4 was lower than that at t1 in the C group(P<0.05).Conclusions: Both remifentanil and propofol TCI anesthesia and isoflurane balanced anesthesia can maintain smooth life signs in surgery of cerebral tumor patients.Patients anesthetized with remifentanil and propofol TCI recover more quickly than those anesthetized with isoflurane balanced anesthesia.Remifentanil and propofol TCI anesthesia can balance the oxygen supply consumption better than isoflurane balanced anesthesia do during the operation.更多还原