全麻拔管期应用乌拉地尔复合丙泊酚临床效果观察

Clinical observation of Urapidil combined with Propofol used in decannulation period of general anesthesia in neurosurgery

目的观察乌拉地尔复合丙泊酚在神经外科手术全麻拔管时应激反应的临床效果。方法神经外科全麻手术36例,分为观察组和对照组各18例。两组均在缝合硬脑膜后停用静脉麻醉药,在开始缝头皮时停用吸入麻醉药,观察组在达到拔管指征后静脉注射乌拉地尔0.2 mg/kg、丙泊酚0.5 mg/kg,5 min后拔管。对照组静脉注射0.9%NS 10 ml后拔管;观察拔管前、拔管后1、5、10 min 2组患者收缩压(SBP)、舒张压(DBP)、心率(HR)、呼吸(RR)、清醒时间等的差异及躁动、呛咳、呕吐、呼吸抑制等应激反应的发生率。结果观察组拔管后应激反应稳定,对照组患者SBP、DBP、HR、RR明显升高(P<0.01);躁动、呛咳、呕吐等不良反应发生率明显升高(P<0.01);患者的清醒时间稍短(P>0.05)。结论乌拉地尔复合丙泊酚在神经外科全麻拔管前静脉注射,可有效抑制应激反应,减少拔管期心脑血管等并发症。

Objective To observe the clinical effect of Urapidil combined with Propofol used in decannulation period of general anesthesia in neurosurgical operations. Methods 36 patients undergoing neurosurgical operations under general anesthesia were randomly divided into experimental group （ n = 18） and control group In = 18 ）. Both groups were stopped using intravenous anesthetic after suturing the cerebral dura mater and inhalation anesthetic at the beginning of suturing epicranium. Patients in experimental group were treated with Urapidil （ 0. 2 mg/kg ） and Propofol （ 0. 5 mg/kg ） via intravenous injection at 5 minutes before decannulation. Patients in control group were given 0. 9% NS 10ml before decannulation. The differences of SBP, DBP,HR,RR,analepsia time and the incidence rate of stress reaction such as restlessness, bucking, respiratory depression between experimental group and control group were compared at 1 minute, 3 minutes, 10 minutes before and after decannulation. Results The stress reaction in experimental group was stable, while SBP, DBP, HR, RR in control group were significantly higher than those in experimental group（ P 〈 0. 01 ）. The incidence rate of stress reaction such as restlessness, bucking, respiratory depression in control group was also significantly higher than that of experimental group （ P 〈 0. 01 ）. The analepsia time in con- trol group was slightly shorter than that in erimentalroup （ P 〉 0. 05 ）. Conclusion Using Urapidil combined with Propofol before decannulation of general anesthesia during neurosurgical operation could inhibit stress reaction effectively, and decrease cardiacerebrovascular complications in decannulation period.