介入性神经放射手术麻醉方法的临床选择

A Clinical Choice of Anesthesia for Intervenient Neuroradiological Surgery

目的:探讨介入性神经放射学手术较为理想的麻醉方法。方法:择期拟血管内治疗术ASAI～Ⅲ级病人1019例,随机分为哌替啶-非那根组(DP组,n=137),氟哌啶-芬太尼组(DF组,n=232),病人自控镇痛组(PCA组,n=517)及异丙酚-芬太尼组(PPF组,n=133)。结果:病人术中疼痛均为0～Ⅰ级,四组间比较无显著性差异(P>0.05)。Ramsay评分为2～3分(平静合作)者,PCA组496/517(95.9％),明显高于DP组96/137例(70.1％),DF组165/232例(71.1％)及PPF组105/133例(78.9％)(P<0.01),Ramsay评分为4～5分(明显～强镇静状态),PCA组0/517例(0％)明显低于DP组32/137例(23.3％),DF组49/232例(21.1％)及PPF组27/133例(20.3％)(P<0.01);但其停药后5分钟内能完成简单指令动作者,PPF组22/27例明显高于DP组0/32例及DF组0/49例(P<0.01)。结论:氟哌啶与芬太尼复合并应用PCA装置给药,可为病人选择到最低有效的负荷量及维持量,是一种较为理想的麻醉方法;但对于手术时间长,术中极度焦虑、紧张、不能合作者,以选用异丙酚-芬大尼组为宜。

Objective To investigate the ideal anesthetic method for the intervenient neuroradiological (INR) surgery. Methods One thousand and nineteen patients with ASA grade Ⅰ-Ⅱ undergoing elective INR surgery were randomly divided into four groups, i. e. dolantin - phenergan group (group DP, n =137), droperidol - Fentayl group ( group DF, n = 232), patient - controlled analgesia group(group PCA, n=517) and propofol- fentayl group (group PPF, n=133). Results In the course of operation,there was no significant difference in analgesia among the four groups ( P>0.05) and the pain in all the patients was within grade 0-Ⅰ. The percentage of the patients whose Ramsay scores was 2 to 3 (responsive to command) in group PCA (95.9% ) was significantly higher than that in group DP (70.1%), group DF (71.1% ) and group PPF (78.9%) ( P<0.001). The percentage of the patients whose Ramsay scores was 4 to 5 (unresponsive to command) in group PCA (0% ) was significantly lower than that in group DP (23.3% ) , group DF (21.1%) and group PPF (20.3%) ( P <0.01). But the percentage of the patients who could finish simple command within 5 minutes after stopping anaesthetizationin group PPF (22/27) was significant higher than that in group DP (0/32) and group DF (0/49) ( P<0.01). Conclusion Coadministration of propofol and fentayl for anesthesia during the INR Surgery with PCA pump made easily choose minimal effective loading and maintaining dose and is an ideal anaesthetic method in the patients undergoing INR Surgery, but coadministration of propofol and fentayl is suitable for the patients undergoing long - time operation and for the anxious nervous and uncooperative ones during INR surgery.