脑血管病介入手术的麻醉管理

Management of anesthesia in intervention surgery of cerebrovascular disease

目的总结脑血管病患者神经介入手术的麻醉管理方法。方法 21例脑血管病患者,ASA分级Ⅰ～Ⅱ级。全组患者给予静脉复合全身麻醉,诱导药给予咪唑安定0.02mg/kg、芬太尼5μg/kg、丙泊酚1.5mg/kg至患者意识消失后推注罗库溴胺0.3mg/kg后行气管内插管,实施机械控制呼吸,术中麻醉维持静脉泵注丙泊酚、芬太尼,必要时术中给予乌拉地尔行控制性降压。结果 21例患者全身麻醉快诱导期间均有短暂的血压轻度下降,气管插管顺利无呛咳,均未引起明显的颅内压升高。术中血流动力学平稳,血压控制满意,有5例患者使用乌拉地尔进行控制性降压。术毕清醒迅速,拔管前均无剧咳、躁动和对抗导管的动作,拔管后待生命体征平稳送回病房。结论气管插管静脉全麻,必要时辅以适当的控制性降压,具有诱导平稳,可控性强,术毕苏醒迅速良好的优点,是一种安全有效的麻醉方法。

Objective To summarize the methods of anesthesia management concerning patients with cerebrovascular disease undergoing intervention surgery. Methods Twenty-one cases with cerebrovascular disease, with classified Ⅰ～Ⅱ according to ASA criteria were under general anesthesia through using several kinds of anesthetics by intravenous approach. All the patients were induced with midazolam 0.02mg/kg, fentanyl 5gg/kg, propofol 1.Smg/kg, followed by rocuronium 0.3mg/kg after loss of consciousness, and then performed intubation and controlled ventilation by anesthesia machine. Anesthesia was sustained with propofol and fentanyl through pump-injected approach during surgery, and gave urapidil i.v. for controlled hypotension if necessary. Results During induction, 21 patients underwent mild transient drop in blood pressure, and intubated smoothly without choking. All the cases were not led to significantly high intracranial pressure caused by intubation. Hemodynamics was kept stable, and blood pressure control was satisfactory.Five of the cases were injected urapidil for controlled hypotension. Patients were awaked quickly after surgery finished. There were no serious cough, restlessness, and the action against the tube before extubation, and all the patients had stable signs after extubation and then were sent back to the wards. Conclusion Intubating under intravenous general anesthesia, if necessary, adding some adjuvant for controlling blood pressure, we can gain many advantages like stable induction, controllable, rapid awakening after surgery etc. It is a safe and effective method of anesthesia.