不同麻药用于颅内血管瘤介入治疗的临床探讨

Clinical Discussion of the Different Anesthetic for Interventional Treatment of Intracranial Aneurysm

目的观察静吸复合或全凭静脉麻醉用于颅内动脉瘤介入治疗的麻醉效果.方法选择30例颅内动脉瘤ASAⅡ～Ⅲ级拟择期介入治疗的病人,随机分为两组(A组、B组),每组15例.A组吸入七氟醚-微泵静注瑞芬太尼;B组微泵静注丙泊酚-瑞芬太尼麻醉维持,观察记录患者的平均血压(MBP)、心率(HR)、氧饱和度(SaO)2的变化及拔管时间、患者拔管后的意识状态及头痛程度.结果生命体征(MBP、HR、SaO)2的变化组间比较差异无统计学意义(P>0.05);而术毕自主呼吸和意识的恢复A组优于B组(P>0.05).结论在颅内动脉瘤介入治疗的麻醉中七氟醚-瑞芬太尼静吸复合麻醉优于丙泊酚-瑞芬太尼全凭静脉麻醉;同时强调,手术时间应控制在6h以内,否则病人的意识恢复仍不够理想.

Objective To observe effects of the intravenous and inhalation compound anesthesia or total intravenous anesthesia for interventional treatment of intracranial aneurysms. Methods Thirty patients of Intracranial Aneurysms ASA Ⅱ - Ⅲ class were randomly divided into two groups （A and B group）. There were 15 cases in each group. A group used sevoflurane inhalation-micro-pump intravenous remifentanil, B group used micro-pump intravenous propofol-remifentanil anesthesia maintenance. We observed changes of mean blood pressure （MBP）, heart rate （HR）, oxygen saturation （SAC2）, extubation, status of consciousness after extubation and headache. Results There was no significant difference in vital signs （MBP, HR, SAC2） between the two groups （P 〉 0.05） ; and recovery of spontaneous breathing and consciousness of patients in A group were superior to B group after surgery. Conclusion The sevoflurane-Remifentanil compound anesthesia is better than propofol-remifentanil total intravenous anesthesia in the intervention treatment of intracranial aneurysms. At the same time, surgery time should be controlled in 6 hours, or the recovery of patient＇s consciousness is still not ideal.