神经外科手术丙泊酚-利多卡因复合静脉麻醉的研究

Application of Intravenous Anesthesia with Lidocaine and Propofol Used for Neurosurgical Operation

目的 为多方面综合评估不同剂量的丙泊酚和利多卡因复合应用于神经外科麻醉的可行性,并摸索适合的临床用药剂量。方法 将60例择期颅脑手术病人,随机分为4 组,给予不同剂量的丙泊酚和利多卡因维持麻醉。连续监测脑电参数和血流动力学参数;记录尼卡地平和艾司洛尔的用量、麻醉恢复时间、不良反应和麻醉并发症。结果 1)诱导后4组病人的双谱指数(BIS)、95%边缘频率(SEF)均明显降低;术中C组BIS值明显低于A组,D组明显高于A组。2)B组和C组艾司洛尔总用量分别比A组减少43.2%和54.4%,尼卡地平总用量分别比A组减少43.4%和54.3%。结论 1)利多卡因可以增强丙泊酚的镇静强度。2)利多卡因具有剂量相关性镇痛作用。3)丙泊酚和利多卡因复合静脉麻醉在神经外科手术中应用具有可行性,推荐剂量为丙泊酚5 mg/kg、利多卡因2.5 mg/kg。

Objective The aim was to evaluate the feasibility of propofol and lidocaine used for neurosurgical surgery and to find out the proper dose. Methods Sixty patients were randomly allocated into four groups with different doses of lidocaine and propofol. BP and HR were controlled by nicardipine and esomolol. BIS,SEF and the hemodynamic parameters were measured continuously; the dose of nicardipine and esomolol, the recovery time and the side-effects were recorded. Results 1) The BIS and SEF values of four groups were all decreased significantly after induction. The BIS values of group C were lower while those of group D were higher than those of group A. 2) The total dose of esomolol in group C and D were 43.2% and 54.4% respectively which was less than that of group A. The total dose of nicardipine in group C and D were 43.4% and 54.3% respectively which was less than that of group A. Conclusion 1) Lidocaine have the power to strengthen the sedition of propofol. 2) Lidocine has the dose-dependent effect of analgesia. 3) Propofol and lidocaine are suitable for neurosurgical surgery and the proper dose is propofol 5 mg/kg and lidocaine 2.5 mg/kg.