七氟醚静吸复合麻醉与瑞芬太尼全凭静脉麻醉用于颅内动脉瘤夹闭术的比较

Comparison of Sevoflurane-remifentanil Compound Anesthesia and Remifentanil Total Intravenous Anesthesia for Intracranial Aneurysm Surgery

目的探讨七氟醚静吸复合麻醉与瑞芬太尼全凭静脉麻醉在颅内动脉瘤夹闭术中的麻醉效果,及其对患者血流动力学和脑电双频指数(BIS)的影响。方法选择ASAⅡ-Ⅲ级颅内动脉瘤患者40例,随机分为七氟醚组(S组)和瑞芬太尼组(R组),2组病例术中均持续静脉靶控输注异丙酚、瑞芬太尼维持麻醉;S组在气管插管后持续吸入0.5%～1.5%七氟醚,R组采用全凭静脉麻醉。分别记录术前(T1)、气管插管(T2)、切皮(T3)、钻颅骨(T4)、动脉瘤夹闭(T5)、缝皮(T6)、拔管(T7)等时间点心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),指脉搏氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、BIS等。结果2组患者各时间点HR、MAP、CVP、BIS组间比较差异无显著性意义(P>0.05)。2组患者麻醉后MAP均显著低于T1(P<0.05)。术中高血压、降压药物的使用率和S组均低于R组(P<0.05)。结论七氟醚静吸复合麻醉与瑞芬太尼全凭静脉麻醉用于颅内动脉瘤夹闭术都能提供满意的麻醉效果,而在降低血压、减少降压药物的使用方面前者优于后者。

Objective To investigate the effects of the sevoflurane-remifentanil compound anesthesia and remifentanil total intravenous anesthesia on hemodynamics and BIS in intracranial aneurysm surgery.Methods Forty ASA Ⅱ-Ⅲ patients undergoing intracranial aneurysm intervention were randomly divided into two groups：sevoflurane group（S group） and remifentanil group（R group）,in S group anesthesia maintained with 0.5%1.5% sevoflurane combined with a target controlled infusion of remifentanil and propofol,R group maintained with total intravenous anesthesia.HR,MAP,CVP,SpO2,PETCO2,BIS were recorded before operation（T1）、intubation（T2）、skin incision（T3）、drilling the skull（T4）、aneurysm（T5）、sewing skin（T6）、extubation（T7）.Results There is no significant difference between HR,MAP,CVP,BIS at time points in the two groups（P〉0.05）.MAP was significantly lower than preoperative（T1）（P〈0.05）.The incidence of hypertension and the utilization of antihypertensive drug in group S was significantly lower than group R,there was significant difference between the two groups（P〈0.05）.Conclusions Sevoflurane-remifentanil compound anesthesia and remifentanil total intravenous anesthesia both provided satisfactory anesthesia for intracranial aneurysm surgery,but in controlling hypertension,decreasing antihypertensive drug usage,sevoflurane-remifentanil compound anesthesia is superior to remifentanil total intravenous anesthesia.