神经外科术中MRI时麻醉深度的调控

Regulation of anesthetic depth during intraoperative magnetic resonance imaging in the patients with intracranial tumors

目的探讨神经外科术中MRI时麻醉深度的调控。方法25例颅内肿瘤患者在气管插管全身麻醉下行术中MRI及导航系统辅助开颅肿瘤切除术。术中维持呼气末七氟醚浓度0.95%～1.05%,并参照患者基础平均动脉压调整瑞芬太尼输注浓度来维持麻醉,使术中平均动脉压维持于不高于基础值10%及不低于基础值20%,维持心率100次/分以下。记录患者钻骨孔、去骨瓣后、剪开硬膜、颅内操作30min、颅内操作1h及MRI扫描前、扫描时、扫描结束时和扫描后重新开始手术的瑞芬太尼浓度、心率、血压、体温变化。结果患者在术中MRI过程中瑞芬太尼的输注浓度与颅内操作时浓度并无统计学差异(P>0.05)。术中生命体征稳定,无麻醉并发症。结论神经外科手术中MRI过程中,虽无手术刺激,但受噪音刺激、手术创面等影响使麻醉深度的维持基本与颅内操作期相同。

Objective To explore the regulation of the anesthetic depth during the period of the intraoperative magnetic resonancei maging（iMRI）in the patients with intracranial tumors.Methods The microsurgery assisted by iMRI and neuronavigation system wasp erformed under general anesthesia in 25 patients with intracranial tumors.They were anesthetized by sevoflurane,of which the end tidalc oncentration ranged from 0.95% to 1.05%,and anesthetic depth was maintained by adjusting the concentration of remifentanil accordingt o the fluctuation of mean arterial pressure（MAP）in order to maintain MAP between-20% and＋10% of baseline and heart rate（HR）lesst han 100 beats per minutes.The concentration of remifentanil,HR,MAP and body temperature were recorded at the different stages of theo peration.Results There was insignificant difference in the concentration of remifentanil between the phase of iMRI scanning and thep hase of the intracranial procedure.The vital signs were stable during the operation in all the patients.Conclusions The anesthetic depthd uring iMRI,is similar to that of the intracranial procedure due to the high noise and open wound surface though the operative stimulations tops in the patients with intracranial tumors.