外伤性颅内血肿清除术的丙泊酚瑞芬太尼静脉麻醉

Intravenous anesthesia of propofol-remifentanil for traumatic intracranial hematoma surgery

目的观察丙泊酚-瑞芬太尼静脉麻醉,在外伤性颅内血肿手术中应用的效果。方法外伤颅内血肿清除术219例,分靶控输注Ⅰ组;静吸复合Ⅱ组。丙泊酚、瑞芬太尼靶浓度为1.5～3mg/L和2～3μg/L。Ⅰ组丙泊酚按5∶4∶3方案,即5、4、3mg/(kg.h)间隔10min;瑞芬太尼(0.33±0.04)μg/(kg.min)输注。Ⅱ组芬太尼常规诱导气管插管后,1%～2%异氟醚吸入维持,间断应用芬太尼。观察气管插管反应、麻醉效果、副作用。结果两组麻醉效果相同(P>0.05),均可抑制气管插管反应(F=5.161,P<0.001),麻醉程度比较差异有统计学意义P<0.05。副作用发生率差异无统计学意义P>0.05,术中无知晓。结论丙泊酚瑞芬太尼靶控输注与芬太尼静吸麻醉效果一致、安全有效。适用于外伤性颅内血肿清除术的麻醉。

Objective To investigate the effect of the total intravenous anesthesia (TIVA) of propofol (PP) -remifentanil (REM) in surgery for traumatic intracranial hematoma. Methods 219 patients with traumatic intracranial hematoma under TIVA were randomly divided into two groups: study group (n=115)receiving ?intravenous target controlled infusion (TCI) of PP-REM (PP was infused 5 mg/kg, 4 mg/kg. and then 3 mg/kg for 10 minutes successively for 10 min each, and remifentanil 2～3 μg/kg was given), and control group(n=104), receiving intravenous injection of fentanyl 3 μg/kg and inspiration of isoflurane 1%～2%. Results The anesthesia efficacy of the study group was similar to that of the control group (P>0.05). A better recovery and fewer side effects were found in the study group compared with the control group.Conclusion The propofol-remifentanil TCI is safe and efficacious for traumatic intracranial hematoma surgery.