经鼻给予布托啡诺对开颅手术麻醉呼气末异氟醚浓度的影响

The effect of intranasal Butorphanol on the end-tidal pressure of Isoflurane in craniotomy

目的:研究麻醉前应用酒石酸布托啡诺鼻喷剂对开颅手术患者术中呼气末异氟醚浓度(PETIso)的影响。方法:采用随机、双盲、对照研究,选择我院择期行开颅手术的患者60例,将其分为布托啡诺组(B组)和生理盐水组(S组),每组30例。B组给予酒石酸布托啡诺2喷(2 mg),S组给予生理盐水2喷。麻醉前15 min给药。术中调节异氟醚浓度,维持平均动脉压(MAP)在基础值的(+10%)～(-20%)范围内。记录手术各个时间点的血压、心率、PETIso及脑电双频指数(BIS)。结果:B组在切皮、钻骨、开骨瓣后的PETIso显著低于S组(P<0.01);B组在剪硬膜、颅内操作开始、颅内操作10、20、30 min和缝硬膜的PETIso低于S组(P<0.05)。结论:麻醉前15 min经鼻给予酒石酸布托啡诺2 mg能有效减少神经外科手术患者开颅期和颅内操作期的PETIso。

Objective： To observe the effect of intranasal Butorphanol on the end-tidal pressure of Isoflurane（PETIso） and the recovery profiles in craniotomy patients.Methods： A randomized,double-blind,parallel study was used.60 patients of our hospital who was undergoing selective craniotomy in this study were selected and divided into Butorphanol group（group B） and normal saline group（group S）,group B was given Butorphanol Tartrate Spray in nasal with 2 puffs（2 mg）;Group S was given normal saline with 2 puffs.The medicine was given 15 minutes before anesthesia induction.The concentration of Isoflurane was adjusted to maintain the mean arterial pressure（MAP） within（＋10%）-（-20%） of baseline and was recorded at each point of operation.The blood pressure,PETIso and BIS were observed.Results： In group B,the PETIso after the points of skin incision,skull drilling,and skull opening were significantly less than that in group S（P〈0.01）;The PETIso in group B at the points of dura incision,intracranial procedure beginning,intracranial 10,20,30 min and suture dura were lower than that in group S（P〈0.05）.Conclusion： The application of Butorphanol Tartrate in nasal with 2 mg about 15 min before anesthesia can effectively decrease the PETIso of neurosurgical patients during skull opening and intracranial procedure.