颅内动脉瘤介入栓塞瑞芬太尼麻醉效果观察

Effect of remifentanil on cough response and hemodynamic stability during extubation in patients with interventional embolization of intracranial aneurysms

目的颅内动脉瘤栓塞术后麻醉复苏期,瘤体内血栓尚未完全形成,拔管期患者呛咳易诱发患者瘤体再出血,影响手术效果及预后。本研究观察瑞芬太尼对预防颅内动脉瘤介入栓塞患者拔管期呛咳反应及血流动力学稳定效果,为颅内动脉瘤介入栓塞麻醉用药选择提供借鉴。方法选择2016-10-01-2018-02-28在南阳市中心医院行全麻下颅内动脉瘤栓塞术患者106例作为研究对象,根据术中维持麻醉药物停止时间不同,将其分为观察组和对照组,各53例。两组术中均采用静吸复合维持麻醉,即靶控输注瑞芬太尼10～15μg/(kg·h)联合七氟烷(浓度为0.5～1.0MAC)持续吸入全麻维持,对照组瑞芬太尼输注至手术结束即刻停药,观察组在手术结束前5min改瑞芬太尼2ng/mL持续靶控输注至麻醉苏醒结束。记录两组患者麻醉复苏刺激反应时间、睁眼时间、拔管时间和总复苏时间,以及拔管期间呛咳发生率、平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)和血氧饱和度(saturation of blood oxygen,SPO2)指数改变。结果观察组与对照组复苏刺激反应时间分别(9.8±2.7)min和(8.7±2.3)min,差异无统计学意义,t=0.673,P=0.153;睁眼时间分别为(15.5±4.4)min和(14.1±3.9)min,差异无统计学意义,t=0.804,P=0.104;拔管时间分别为(23.4±6.5)min和(21.9±6.1)min,差异无统计学意义,t=1.018,P=0.994;总复苏时间分别为(30.8±7.3)min和(28.5±6.9)min,差异无统计学意义,t=1.434,P=0.905。观察组拔管期间呛咳发生率为11.32%,明显低于对照组的52.83%,组间比较差异有统计学意义,χ~2=8.164,P=0.015。观察组T2时MAP为(98.7±4.7)mm Hg,优于对照组的(112.5±5.4)mm Hg,t=4.671,P=0.026;HR为(95.3±5.8)次/min,优于对照组的(124.5±8.7)次/min,t=6.893,P=0.014;SPO2为(96.6±1.3)%,优于对照组的(93.3±1.7)%,t=3.197,P=0.043。结论瑞芬太尼可显著改善颅内动脉瘤介入栓塞全麻患者苏醒期血流动力学改变,降低拔管期呛咳发生率,稳定颅内压,且不延长复苏时间,对预防颅内动脉瘤介入栓塞术后在出血具有重要意义。

OBJECTIVE In the anesthesia resuscitation period after intracranial aneurysm embolization,the thrombus in the tumor has not yet fully formed.The cough response of patients with extubation can induce hemorrhage in the tumor,which affects the surgical outcome and prognosis.This study aims to observe the effect of remifentanil on prevention of cough response and hemodynamics during extubation in patients with intracranial aneurysm embolization,and to provide reference for the anesthesia choice of intracranial aneurysm interventional embolization.METHODS A total of106 patients were selected as subjects,who underwent general anesthesia for intracranial aneurysm embolization in Nanyang Central Hospital from October 1,2016 to February 28,2018.According to the different time of stopping anesthesia during operation,they were divided into observation group and control group,with 53 cases in each group.In both groups,intravenous-inhalant combined anesthesia was used to maintain anesthesia,that was,target-controlled infusion of remifentanil[10-15μg/(kg·h)]combined with sevoflurane(concentration of 0.5-1.0MAC)continued inhalation of general anesthesia maintenance.Remifentanil was infused to the end of the operation and the drug was discontinued in control group.The observation group was given target-controlled infusion of remifentanil at 2ng/ml from 5minutes before the end of the operation to the end of anesthesia recovery.The anesthesia resuscitation response time,blink time,extubation time and total resuscitation time of the two groups were recorded,as well as the incidence of cough during the extubation,mean arterial pressure(MAP),heart rate(HR),the saturation of blood oxygen(SpO2).RESULTS The response time of resuscitation in the observation group was(9.8±2.7)min,the time of blinking was(15.5±4.4)min,the time of extubation was(23.4±6.5)min,and the total recovery time was(30.8±7.3)min.In the control group,the response time of resuscitation stimulation was(8.7±2.3)min,the time of blinking was(14.1±3.9)min,the time of extubation was(21.9±6.1)min,and the total recovery time was(28.5±6.9)min.There were no statistically significant differences in these indicators between the two groups.The t values were 0.673,0.804,1.018,and 1.434,respectively,and the Pvalues were 0.153,0.104,0.994,and 0.905,respectively.The incidence of cough during the extubation in the observation group was 11.32%,which was significantly lower than that in the control group(52.83%).The difference between the two groups was statistically significant,χ^2=8.164,P=0.015.The MAP of the observation group at T2 was(98.7±4.7)mm Hg,which was better than that of the control group(112.5±5.4)mm Hg,t=4.671,P=0.026.The HR was(95.3±5.8)times/min in observation group,which was better than that in the control group(124.5±8.7)times/min,t=6.893,P=0.014.The SpO2 was(96.6±1.3)%,which was better than that in the control group(93.3±1.7)%,t=3.197,P=0.043.CONCLUSION Remifentanil can significantly improve the hemodynamic changes during the general anesthesia recovery period of patients with interventional embolization of intracranial aneurysms,reduce the incidence of cough during extubation,stabilize intracranial pressure,and not prolong the recovery time,and prevent bleeding of intracranial arteries.