异丙酚对颅内动脉瘤夹闭术患者术后苏醒的影响

The effect of propofol intravenous anesthesia in evaluation of postoperative awaken after intracranial aneurysm surgery

目的 评价异丙酚静脉麻醉对颅内动脉瘤夹闭手术患者术后苏醒的影响。方法选择择期全麻下行颅内动脉瘤夹闭手术患者64例,ASA分级为Ⅱ~Ⅲ级,年龄30~60岁,随机分为异丙酚组和咪达唑仑组。麻醉诱导时异丙酚组缓慢静脉注射异丙酚1.5~2.0 mg/kg,咪达唑仑组静脉注射咪达唑仑0.15~0.2 mg/kg,至意识消失,后静脉注射芬太尼6μg/kg、潘可罗宁0.08~0.1 mg/kg行气管插管。麻醉维持采用微量泵行恒速输注,2组分别为异丙酚8 mg.kg-1.h-1,10 min后减至6 mg.kg-1.h-1,20 min后减至4 mg.kg-1.h-1;咪达唑仑0.2mg.kg-1.h-1,10 min后减至0.15 mg.kg-1.h-1,20 min后减至0.125 mg.kg-1.h-1。分别于术后5、10、20、30、60 min记录Glasgow昏迷分级评分(Gcs)及睁眼时间、对简单命令有反应时间、拔管时间。术后第1天及第3天询问患者是否有术中知晓。结果异丙酚组患者的Glasgow昏迷评分高于咪达唑仑组(P<0.05),异丙酚组患者睁眼时间、对简单命令有反应时间、拔管时间均短于咪达唑仑组(P<0.05),2组患者术后第1、3天均无术中知晓。结论颅内动脉瘤手术中使用异丙酚静脉麻醉对患者的术后苏醒优于咪达唑仑。

Objective To access the effect of propofol intravenous anesthesia in evaluation of postoperative awaken after intracranial aneurysm surgery.Methods 64 ASA Ⅱ or Ⅲ patients aged 30～60 years,undergoing intracranial aneurysm surgery were enrolled in this study.The patients were divided into Propofol group and Midazolam group.During the induction of general anesthesia,Propofol group slowly intravenous propofol 1.5～2.0 mg/kg,Midazolam group slowly intravenous midazolam 0.15～0.20 mg/kg until unconsciousness,then intravenous fentanyl 6 μg/kg,pancanberonin 0.08～0.1 mg/kg,then perform endotracheal intubation.During the maintenance of anesthesia,apply micro-pump inject constantly,Propofol 8 mg·kg^（-1）·h^（-1）,after 10 min reduce to 6 mgkg·h,after 20 min reduce to 4 mg/kg·h and then maintain the speed,midazolam 0.2 mg·kg^（-1）·h^（-1）,after 10 min reduce to 0.15 mg·kg^（-1）·h^（-1）,after 20 min reduce to 0.125 mg·kg^（-1）·h^（-1）.Record the Glasgow Coma classification rating（Gcs） at the time of 5min,10 min,20 min,30 min,60 min after surgery,and the open time,for simple commands have reaction time,extubation time were recorded.After the first and third day of surgery the patients were asked about if they had the intraoperative awareness.Results The patient Glasgow Coma classification rating in propofol group was higher than midazolam group（P0.05）.The open time,for simple commands have reaction time,extubation time in propofol group was shorter than midazolam group（P0.05）.Conclusion Propofol intravenous anesthesia is superior to midazolam in evaluation of postoperative awaken after intracranial aneurysm surgery.