芬太尼、丙泊酚不插管静脉全麻用于颅脑外科手术的可行性随机双盲对照研究

Fentanyl propofol intravenous anesthesia without intubation for brain surgery the feasibility of randomized double-blind controlled study

目的探究芬太尼、异丙酚全凭静脉不插管全麻用于出血性颅脑外科手术的可行性。方法选择120例(有心肺疾病及呼衰患者除外)硬膜外血肿、脑出血、蛛网膜下腔出血的患者为研究对象,随机分为全凭静脉麻醉(TIVA)与静吸复合麻醉(C)两组。TIVA组(n=60例)入室后鼻导管吸氧5L/min,切皮前给予芬太尼0.05～1mg,0.5%利多卡因表面浸润麻醉,丙泊酚0.6～1.2mg/kg缓慢静脉注射;术中维持丙泊酚4～6mg/(kg·h),适时追加芬太尼0.05mg/次,静脉注射,手术结束前10min停药;C组(n=60例)诱导采用芬太尼2μg/kg,异丙酚2.5mg/kg及琥珀胆碱1.5mg/kg后经口插管,维持采用异丙酚4～6mg/(kg·h)+异氟醚(维持呼出浓度在0.8～1.2MAC)静吸复合麻醉,手术结束前30min关闭异氟醚吸入,改用异丙酚6～8mg/(kg·h)输注,切皮前5min及术中追加芬太尼。观察记录诱导前、术中15min、术中30min、术毕的MAP、HR、RR、SPO2;术中术者满意度、术中躁动、呕吐发生率、术中心跳骤停发生率;术后好转率;二次出血率。结果 TIVA组与C组比较,术者满意度、躁动发生率,有明显差别,差异有统计学意义(P<0.05);MAP、HR、RR、SPO2、呕吐发生率、术中心跳骤停发生率、术后好转率、二次出血率,无明显差别。结论芬太尼、丙泊酚不插管静脉全麻可以用于颅脑外科手术的麻醉。

Objective Inquiry fentanyl, propofol total intravenous anesthesia without intubation （TIVA） for hemorrhagic cerebral surgery is feasible. Methods Choose 120 （with heart and lung disease and respiratory failure in patients excluded） epidural hematoma, cerebral hemorrhage, subarachnoid hemorrhage patients in this study were randomly divided into total intravenous anesthesia （TIVA） with inhalation anes- thesia （C） two groups. TIVA group （ n = 60 cases） after the burglary nasal cannula oxygen 5 lMmin, before skin incision fentanyl 0.05 - 1 mg, 0.5 % lidocaine surface anesthesia, propofol 0.6 ·1.2 mg/kg slow intravenous injection ; maintain intraoperative propofol 4 - 6 mg / （ kg ·h）, timely additional fentanyl 0.05 mg/second,intravenous injection, 10 min before the end of surgery withdrawal; C group （n = 60 cases） induced the use of fentanyl 2μg/kg, propofol 2.5 mg/kg and succinylcholine 1.5 mg/kg after oral intubation, maintained with propofol 4 - 6 mg/（ kg · h） ＋ isoflurane （ to maintain the concentration of exhaled in 0.8 - 1.2 MAC） inhalation anesthesia, 30 min before the end of surgery isoflurane off, switch to propofol 6- 8 mg/（ kg · h） infusion, 5 min before skin incision and intraoperative in additional fentanyl. Observed and recorded before induction, patients in 15 min, surgery 30 min, surgery of the MAP, HR, RR; surgery patients were satisfied with the degree of intraoperative restlessness and vomiting, the incidence of intraoperative cardiac arrest; postoperative improvement rate. And compare the costs of two groups of patients with anesthesia. Results TIVA group and C group, patients were satisfied with the degree of agitation rate, there are significant differences, the difference was statistically significant （P 〈 0.05） ; MAP, HR, RR, SPO2, the incidence of vomiting, the incidence of intraoperative cardiac arrest , postoperative improvement rate, the rate of secondary bleeding, no significant difference. Conclusion fentanyl, propofol intravenous anesthesia without intubation can be used in brain surgery anesthesia.