靶控输注瑞芬太尼复合异丙酚在脑动脉瘤介入栓塞术中的临床观察

The clinical observation of target-controlled infusion of remifentanil and propofol in the interventional embolization of cerebral aneurysms

目的探讨靶控输注瑞芬太尼复合异丙酚对脑动脉瘤栓塞介入术患者围术期血流动力学的影响。方法选择2011年1月～2012年12月的40例择期行脑动脉瘤栓塞介入术的患者,ASAⅡ～Ⅲ级,年龄45～68岁,体重52～65 kg,体重指数≤25 kg/m2,随机分为瑞芬太尼组(R组)和舒芬太尼组(S组),每组各20例。麻醉诱导时,R组的异丙酚血浆靶浓度从3μg/mL开始,与8 ng/mL瑞芬太尼同时靶控输注诱导;S组的异丙酚血浆靶浓度也从3μg/mL开始,同时静注舒芬太尼0.8μg/kg诱导插管。待患者意识消失后静注顺式阿曲库铵辅助插管,分别记录患者麻醉诱导前(T0)、诱导后(T1)、股动脉穿刺(T2)、填塞钢圈(T3)、栓塞术毕(T4)等各时点的平均动脉压(MAP)、心率(HR)、心输出量、每搏量、血流峰速度、血流加速度、左室射血时间、体循环阻力(SVR)及脑电双频指数(BIS)。结果两组患者的BIS值在T0-T4各时点均无显著性差异(P>0.05),插管后S组的收缩压较插管前增高(P<0.05),而R组则无差异。R组患者术中各时点的血液动力学指标与T0相比均保持较低水平,而S组患者在T2和T3时点出现明显的心率增快和MAP降低。两组患者术中不同时点食道超声监测血流动力学的结果显示:与R组相比,S组的CO、SV、PV和TSVR在T3和T4时点均明显地降低(P<0.01)。结论脑动脉瘤介入栓塞术中靶控输注瑞芬太尼复合异丙酚时,机体应激反应小,使得患者围术期生命体征更加平稳。

Objective To investigate whether target-controlled infusion of remifentanil and propofol could prevent fluctuation of hemodynamics with patients undergoing cerebral aneurysm embolization. Methods From January 2011 to December 2012,40 patients undergoing elective cerebral aneurysm embolization surgery patients（ASA Ⅱ-Ⅲ, aged 45 to 68 years old,weighing 52-65 kg,BMI ≤25 kg/m2） were randomly divided into the remifentanil group （R） and sufen- tanil group （S）, 20 individuals in each group. During the period of anesthesia induction, the target plasma concentra tion of propofol in R group was starting from 3 μg/mL, and combined with 8 ng/mL remifentanil target-controlled infu- sion.The target plasma concentration of propofol in S group was also starting from 3 μg/mL,moreover,0.8 μg/kg sufentanil was used to induce intubation. After the patients lost their consciousness,the intravenous injection of Cis- atracurium was used to assist intubation. The mean arterial pressure （MAP）,heart rate （HR）,cardiac output, stroke volume,blood flow peak velocity,blood flow acceleration,left ventricular ejection time,systemic vascular resistance （SVR）, and bispectral index（BIS） were recorded at each time points,including before the induction of anesthesia（T0）, after the induction of anesthesia （T1）,femoral artery puncture （T2）, stuffing the rims （T3）, the end of embolization surgery（T4）. Results The BIS values of patients at T0-T4 time point had not obviously difference（P 〉 0.05） between two groups. Compared with TO time point,the hemodynamic indexes of patients in R group maintained a low level, while the heart rate of patients in S group was significantly increased （P 〈 0.05）, and the MAP of patients was obviously decreased（P 〈 0.05） at the femoral artery puncture（T2） and packing rims（T3） time point. The hemodynamic monitor- ing results of two groups patients undergoing TEE at different time points showed that the CO, SV, PV and TSVR of S group in T3 and T4 time points were significantly lower than R group（P 〈 0.01 ）. Conclusion The target-controlled infusion of remifentanil and propofol reduced the stress response,and made the hemodynamics of patients more stable in the perioperative of cerebral aneurysm embolization surgery.