监测麻醉与睡眠-清醒-睡眠技术用于脑功能区肿瘤手术术中唤醒的对比观察

Awake craniotomy for brain tumors near eloquent cortex: A comparison of monitored anesthesia care with asleep-awake-asleep

目的:对比观察监测麻醉与睡眠-清醒-睡眠技术在脑功能区肿瘤手术术中唤醒的安全性和有效性。方法:选择脑功能区肿瘤病人32例,随机数字表法均分为监测麻醉(MAC)组和睡眠-清醒-睡眠麻醉(AAA)组。分别在MAC和AAA麻醉下行清醒开颅脑功能区肿瘤切除术。记录病人上头架前后、切皮前后、颅骨钻孔前后和缝皮前后MAP和HR变化。计算麻醉药、升压药和降压药用量,并记录唤醒时间、手术结束到出室时间和不良反应发生情况。结果:与AAA组相比较,MAC组上头架前后、切皮前后、颅骨钻孔前后和缝皮前后MAP和HR变化幅度明显偏小,麻醉药和升压药量明显偏少,唤醒和出室时间明显缩短,术后恶心发生明显减少,缺氧、二氧化碳蓄积和呼吸抑制次数明显增多(P均<0.05)。结论:MAC和AAA均可安全用于脑功能区肿瘤手术术中唤醒;MAC较AAA唤醒更快,血流动力学更稳定,围术期恶心呕吐发生率更低,但更易出现可接受的呼吸抑制。

Objective：To compare the monitored anesthesia care（MAC）with asleep - awake - asleep（AAA） technique in awake craniotomy for brain tumors near eloquent cortex. Methods：Thirty - two patients with brain tumors near eloquent cortex were randomly divided into monitored care anesthesia group and asleep - awake - asleep group. Tumor resection under awake craniotomy was performed using MAC and AAA technique. The variation of MAP and HR before and after application of head frame,skin incision,sphenotresia,skin suture were recorded. The doses of anethetic,vasopressor,antihypertensive medicine were calculated. The awaken time,time from the end of the surgery till the patients left the operating room,the incidence of adverse events were also recorded. Results：Comparing with AAA group,the viariation of MAP and HR before and after head framing,skin incision,sphenotresia and skin suture were significantly lower,the dose of anethetic and vasopressor were significantly fewer,the awaken time and time leaving the operating room were significantly shorter,the frenquency of nausea vomiting was significantly fewer,the complications of anoxia hyperoapnia and respiratory depression were significantly higher（P all 〈 0. 05）. Conclusion：MAC and AAA can be used safely in awake craniotomy for brain tumors near eloquent cortex. MAC was quicker in awake,more stable in hemodynamic,less in perioperative nausea vomiting,but easier in acceptable respiratory depression.