术中唤醒麻醉药物调控与清醒程度的研究

A study of the control of anesthetic drugs and the level of consciousness on the intraoperative wake-up

目的观察大剂量瑞芬太尼静脉麻醉方案对脑功能区手术术中唤醒患者清醒程度的效果。方法累及脑功能区致痫灶切除手术20例。通气方式:20例累及语言功能区均采用自行研制的食道鼻咽腔导管插管。麻醉用药:较大剂量的瑞芬太尼[(0.3～0.5μg/kg.min)]+小剂量丙泊酚和顺式阿曲库铵复合。观察术中血压、心率、苏醒时间和清醒程度。结果术中需唤醒者共20例,平均苏醒时间(15.6±3.2)min,平均唤醒期监测时间(43±20)min。上头架时平均动脉压、心率比较平稳(P>0.05),唤醒期皮质监测期平均动脉压和心率多有升高且有统计学差异(P<0.05)。清醒程度评估优良率达93%。结论食道鼻咽腔导管解决了语言功能区手术,气道管理与通气和说话的矛盾。在麻醉方案上,以较大剂量的瑞芬太尼复合小剂量丙泊酚和顺式阿曲库铵可获得麻醉期足够的麻醉深度确保机械通气患者安全舒适。术者手术方便,唤醒时停药后患者苏醒快而平稳,清醒质量高,能带管说话。本研究的术中唤醒麻醉技术,通气方式达到了真正意义上的"麻醉-唤醒-麻醉"的AAA模式而非"睡眠-唤醒-睡眠"的AAA模式。

Objective To observe the effect of intravenous anaesthesia with a high dose Remifentanyl on the brain area matching program intraoperative wake-up on the level of consciousness.Methods The brain areas involved to epileptic foci in 20 cases of surgery.Ventilation method： 20 cases involving language areas of the esophagus using self-developed esophageal nasopharyngeal catheter,with good ventilation effectiveness,and to speak with tube.Maintained with high-dose Remifentanyl [0.3~0.5 μg/（kg·min）],low-dose Propofol and low-dose Cisatracurium.Intraoperative BP,HR,recovery time and level of consciousness were written down.Results There were 20 cases of intraoperative wake-up,recovery time was（15.6 ± 3.2）min,average inspect time was（43±20）min.Mean aortic pressure（MAP） and heart rate（HR） have risen when awaken（P〈0.05）.Alertness rating： good rate was 93%.Conclusion The esophageal nasopharyngeal catheter solved the conflict that patient involving language areas can not speak with airway management.Program on anesthesia showed that high-dose Remifentanil combined with small doses Propofol and Cisatracurium anesthesia available adequate depth of anesthesia,mechanical ventilation to ensure patient safety and comfort.Of the operator convenience,wake-up time after treatment in patients with rapid recovery and a smooth,clear and high quality,can take control speech.In this study,the intraoperative wake-up anesthesia,ventilation means of achieving a true sense of the ＂anesthesia-awake-anesthesia＂,the AAA mode rather than ＂asleep-awake-asleep＂the AAA model.