丙泊酚-瑞芬太尼和丙泊酚-芬太尼复合麻醉用于颅内肿瘤切除手术的临床对比

Comparison of Propofol-Remifentanil and Propofol-Fentanyl in Patients Undergoing Surgery for Intracranial tumor

目的比较丙泊酚-瑞芬太尼和丙泊酚-芬太尼静脉复合麻醉用于颅内肿瘤切除手术中对血流动力学和苏醒的影响。方法60例ASAII～III级行颅内肿瘤切除手术的患者随机分为两组,PR组采用丙泊酚和瑞芬太尼诱导,以丙泊酚80μg/(kg.min)和瑞芬太尼0.16μg/(kg.min)维持;PF组采用丙泊酚和芬太尼诱导,以丙泊酚80μg/(kg.min)和间断推注芬太尼2μg/kg维持。两组均记录术前、麻醉诱导后、气管插管时、头架固定、切皮、切开硬脑膜、关闭硬脑膜各时点的血压、心率值。手术结束后记录睁眼时间、拔管时间和不良反应。结果气管插管后,PF组的收缩压、舒张压、心率、平均动脉压均明显高于PR组(P<0.05)。睁眼时间、拔管时间PR组明显短于PF组(P<0.05)。两组不良反应发生率无明显差别。结论与丙泊酚-芬太尼静脉复合麻醉相比,丙泊酚80μg/(kg.min)和瑞芬太尼0.16μg/(kg.min)静脉复合麻醉苏醒更加迅速,能更好地控制术中血压变化,而且并不增加不良反应发生率。

Objecte To compare the effect of propofol-remifentanil（PR） on the hemodynamics and consciousness recovery with that of propofol-fentanyl （PF） in patients undergoing surgery for intracranial tumors. Methods Sixty patients with American Society of Anesthesiologist （ASA） grades Ⅱ to Ⅲ who were undergoing surgery for intracranial tumors were randomly divided into two groups i. e. PR group and PF group. In PR group, anesthesia induction was performed by means of propofol and remifentanil ,and anesthesia was maintained with an infusion of propofol at a rate of 80μg/（kg · min） plus remifenanil at a rate of 0.16μg/（kg · min）. In PF group,anesthesia induction was performed by propofol and fentanyl,and anesthesia was maintained with bolus doses of femanyl （2 μg/kg） plus infusion of propofol at a rate of 80μg/（kg · min）. In both the groups, heart rate and blood pressure were recorded at baseline,after anesthesia induction, and on tracheal incubation, head holder application, skin and dural incisions, and dural closure. At the end of the surgery, time of extubation and eye opening, and side effects were recorded. Results After the tracheal imubation, systolic arterial pressure, diastolic arterial pressure, heart rate, and mean arterial pressure values were significantly higher in the PF group than than in PR group（ P 〈0.05）. The time of incubation lasting and losing consciousness was significamly shorter in the PR group than that in the PF group （ P d0. 05）. The side effects were similar to each other in both the groups. Conclusion Remifenianil at a dose of 0. 16μg/（kg · min） plus propofol at a rate of 80μg/（kg · min） led to rapid recovery of consciousness from anesthesia, good comrol of hemodynamic responses, and similar side effects in patiems undergoing surgery for intracranial tumors compared with giving intravenously bolus doses of fentanyl （2μg/kg） plus propofol.