丙泊酚和咪达唑仑靶控镇静在颅内动脉瘤介入治疗中的对比研究

Sedation Effects of Target-controlled Infusion of Propofol or Midazolam on Patients with Intracranial Aneurysms during Endovascular Treatment

目的研究丙泊酚和咪达唑仑靶控输注清醒镇静用于颅内动脉瘤介入治疗的可行性。方法40例Hunt-Hess0～Ⅱ级的颅内动脉瘤患者,随机分为丙泊酚组(P组)和咪达唑仑组(M组),每组20例。术中分别采用丙泊酚和咪达唑仑实施靶控输注观察清醒镇静。记录清醒镇静评价(OAA/S)评分不同时相应的MAP、HR、SpO2和脑电双频谱指数(BIS),以及两种药物的靶浓度(Ct)和效应室浓度(Ce)。结果随着OAA/S评分下降,MAP、HR和SpO2均明显下降(P<0.05);随着Ct、Ce的增加,镇静逐渐加深,OAA/S评分降低,BIS明显下降(P<0.05);P组镇静诱导时间和苏醒时间均短于M组(P<0.05)。结论丙泊酚和咪达唑仑TCI清醒镇静均可用于颅内动脉瘤介入治疗,但丙泊酚安全性更高,患者合作程度更高。

Objective To investigate the feasibility of target-controlled infusion （TCI） of propofol or midazolam for sedation in patients with intracranial aneurysms undergoing endovascular treatment. Methods Forty patients （Hunt-Hess grades 0- Ⅱ ） with intracranial aneurysms undergoing endovascular treatment were randomly divided into both propofol group （n=20）, where the patients received TCI of propofol, and midazolam group （n=20）,where the patients received TCI of midazolam. The level of sedation was evaluated by observer＇s assessment of alertness/sedation（OAA/S） scale. Target eoncentration（Ct） and effect concentration（Ce）, mean arterial pressure （MAP）, heart rate （HR）, SpO2, bispeetral index （BIS） and satisfaction of sedation in all the patients were recorded. Results With the decrease in the OAA/S score, MAP, HR and SpO2 also decreased significantly in both the groups （P〈0.05）. And with the increase in C, and Co, the depth of the sedation increased gradually, and the OAA/S scores and BIS dropped （P〈0.05）. The induction phase and time from sedation to analepsia were significantly shorter in propofol group than these in midazolam group （P〈 0.05）. Conclusions TCI of propofol or midazolam may be used for conscious sedation in patients with intracranial aneurysms undergoing endovaseular treatment, but TCI of propofol has the advantages such as easy control of appropriate sedation and the higher levels of cooperation of the patients with the surgeons compared to TCI of midazolam.