异丙酚-瑞芬太尼麻醉下不同人工气道模式对大脑皮质功能区手术术中唤醒试验效果的影响

Effect of laryngeal make airway or nasotracheal intubation airway on intra-operative wake-up test in patients during operation on cerebral cortical functional area under propofol-remifentanil anesthesia

目的评价经喉罩插管和经鼻气管插管两种人工气道模式对靶控输注（target controlled infusion，TCI）异丙酚瑞芬太尼麻醉下大脑皮质功能区手术术中唤醒试验效果的影响。方法择期行大脑皮质功能区手术的患者20例，将致病灶位于语言中枢以及同时位于语言中枢和运动中枢的患者称为喉罩组（I组），将致病灶位于运动中枢的患者称为气管插管组（Ⅱ组）。两组患者的麻醉诱导均采用异丙酚瑞芬太尼TCt，I组至意识消失后行喉罩插管，Ⅱ组待患者进入深睡眠状态后，经鼻气管插管，两组患者的麻醉维持均采用异丙酚瑞芬太尼TCI，按相同的脑电双频指数（BIS）值来调整血药靶浓度。术中行唤醒试验，记录唤醒时间。记录麻醉诱导即刻（T1）、插管后10min（T2）、患者能按指令活动时（T3）的平均动脉压（MAP）、心率（HR）、呼气末二氧化碳分压（P ET CO2）的变化，同时记录两组患者唤醒期间的相关并发症。结果所有患者均完成唤醒试验，唤醒时间分别为（16．9±2．4）min（I组）、（15．7±1．8）min（II组），两组患者唤醒时间差异无统计学意义（P〉0．05）；唤醒期间Ⅱ组恶心、呕吐，高碳酸血症，脑膨胀的发生率（0％）显著低于I组（20％）（P〈0．05）。结论对病灶位于大脑皮质运动中枢的患者，尽量使用TCI异丙酚端芬太尼麻醉下经鼻气管插管的人工通气模式，可以提高术中唤醒试验的效果。

Objective To investigate the effect of laryngeal mask airway（LMA ） and transnasal tracheal intubation airway on intraoperative wake-up test in patients during operation on cerebral cortical functional area under propofol-remifentanil anesthesia administered by target controlled infusion （TCI）. Methods Twenty ASA I - II patients undergoing neurosurgery on cerebral cortical functional area were divided into two groups （n= 10） by different surgery sites： Group I - in the language centre or/and motive centre, Group II - in the motive centre. TCI technique was used in induction and maintenance during propofol-remifentanil anesthesia in two both groups. Under deep sedation, an LMA was inserted in group I, whereas nasotracheal intubation in group II. We carried on wake-up test during the operation, and defined the wake-up time as the duration from interruption of anesthesia to the moment patients responded to commands, and recorded the variables of mean arterial pressure（MAP）, heart rate（HR）, and end tidal carbon dioxide （PET CO2） at different time-point including anesthesia induction （T1）, 10 min after intubation（T2） and wake-up time（T3）, the corresponding target plasma concentration of propofol and remifentanil and adverse events during wake -up test were also recorded simultaneously. Results All patients completed wake-up test during operation successfully. The wake-up time was （16.9±2.4） min and （15.7±1.8） rain in group I and II respectively, without reaching significant change in both groups （P〉0.05）. But during intra- operative wake-up test, the incidence of vomiting, hypercapnia and brain swelling were significantly lower in group It （0%） than in group I （20%） （P〈0.05）. Conclusion Compared with LMA, nasotracheal intubation airway can increase the effect of wake-up test while using TCI technique with propofol- remifentail anesthesia in patients underwent operations in the site of cerebral cortical motive centre.