异丙酚-氯胺酮复合麻醉对颅脑手术患者颅内压的影响

The effect of ketamine-propofol complex anesthesia on intracranial pressure in neurosurgical patients

目的 研究异丙酚 -氯胺酮复合麻醉对颅脑手术患者颅内压、血流动力学及麻醉苏醒期的影响。方法选择 30例颅脑手术病人 ,麻醉前于L3～ 4 椎间隙穿刺 ,蛛网膜下腔置管测压 ,异丙酚、芬太尼及潘可罗宁常规诱导 ,随机将病人分成 2组 :Ⅰ组术中维持以异丙酚 4mg·kg-1·h-1、氯胺酮 2mg·kg-1·h-1持续微泵静脉滴注 ,Ⅱ组术中维持以同等剂量异丙酚复合 1%～ 2 %异氟醚 ,观察术前、切皮、钻颅骨、打开硬膜时颅内压的变化 ,Datex监护仪持续监测ECG、脉搏氧饱和度 (SpO2 )及有创监测动脉血压、中心静脉压 (CVP)的变化 ;同时观察麻醉苏醒期病人血流动力学变化和恢复期的不良反应。结果 异丙酚 -氯胺酮复合麻醉术中循环稳定 ,颅内压降低的同时可维持满意的脑灌注 ,苏醒过程平稳 ,呛咳、屏气及躁动等不良反应发生少 ;而异丙酚复合异氟醚吸入麻醉在降低血压的同时使颅内压下降 ,并伴随明显的脑灌注减少。结论 异丙酚

Objective To evaluate the effect of ketamine-propofol complex anesthesia on intracranial pressure (ICP), hemodynamics and recovery reactions in intracranial operation.Methods Thirty patients undergoing intracranial operation were canulated at L 3-4 for continuous monitoring of the ICP. The patients were randomly divided into 2 groups. In group Ⅰ, the anesthesia was maintained intravenously with ketamine 2 mg·kg -1 ·h -1 and propofol 4 mg·kg -1 ·h -1 ,whereas in group Ⅱ, inhaled 1%-2% isoflurane and intravenous propofol of the same dose were given for the purpose. ICP was recorded before operation and on incising the skin, boring the cranium and cutting the dura mater. The changes in ECG, SpO 2, arterial BP and CVP were recorded during the operation. Hemodynamic changes and adverse reactions in the period of recovery were noted.Results A significant decrease in ICP accompanied by stable blood circulation and satisfactory cerebral perfusion, and rare adverse reactions (breathlessness, cough, fidgety during recovery) were noted in group Ⅰ. While in group Ⅱ, the significant decrease in ICP was accompanied by drop of BP and lowered cerebral perfusion as well.?Conclusion Ketamine-propofol complex anesthesia can be applied securely for intracranial operation.