静脉麻醉在颅内动脉瘤栓塞术中的应用效果

Clinical effect of intravenous anesthesia in intracranial aneurysm embolization

目的分析静脉麻醉在颅内动脉瘤栓塞术中的应用效果。方法选取2014年4月至2015年4月间收治的60例颅内动脉瘤栓塞术患者,采取随机数字表法分为静脉麻醉组和吸入麻醉组,每组各30例。两组患者均先给予丙泊酚、咪达唑仑和顺式阿曲库铵行麻醉诱导,静脉麻醉组患者采用丙泊酚和瑞芬太尼靶控输注,吸入麻醉组患者采用持续吸入七氟醚,比较两组患者的血流动力学及术后苏醒质量情况。结果静脉麻醉组患者拔管后5 min,平均动脉压及心率较诱导前均明显上升(均P<0.05),吸入麻醉组患者拔管后5 min,平均动脉压及心率较诱导前均明显上升(均P<0.05),吸入麻醉组拔管后5 min,平均动脉压及心率较静脉麻醉组均明显上升(均P<0.05)。与吸入麻醉组相比,静脉麻醉组患者的呼吸恢复时间、拔管时间、呼叫睁眼时间及离开手术时间均明显缩短(均P<0.05)。与吸入麻醉组相比,静脉麻醉组的简易精神状态检查表(MMSE)评分明显升高(t=3.92,P<0.05)。结论静脉麻醉和吸入麻醉均可维持颅内动脉瘤介入栓塞术中稳定的血流动力学,但静脉麻醉后患者苏醒质量更佳。

Objective To explore clinical effect of intravenous anesthesia in intracranial aneurysm embolization. Methods From April 2014 to April 2015, 60 patients with intracranial aneurysm emboliza- tion in The Second Chinese Medicine Hospital of Shenyang were selected and divided into the intravenous anesthesia group and inhalation anesthesia group, 30 cases in each group. Patients in two groups were first given propofol, midazolam, and cis atracurium anesthesia induction. Intravenous anesthesia group was given propofol and remifentanil target controlled infusion. Inhalation anesthesia group received continuous inhala- tion of sevoflurane. The hemodynamic and postoperative recovery of the two groups were compared. Results Mean arterial pressure and heart rate at after extubation 5 min in intravenous anesthesia group compared to before the induction were significantly increased （P 〈 0. 05 for all）. Mean arterial pressure and heart rate at after extubation 5 min in inhalation anesthesia group compared to before the induction were significantly in- creased （ P 〈 0. 05 for all）. The mean arterial pressure and heart rate of the 5 min after extubation in inha- lation anesthesia group were significantly increased than intravenous anesthesia group （ P 〈 0. 05 for all）. Compared with inhalation anesthesia group, patients breathing recovery time, drawing tube time, call eyes time and leave the operation time in intravenous anesthesia group was significantly shorter （ P 〈 0. 05 for all）. Compared with the inhalation anesthesia group, the Simple Mental State Examination （MMSE） score of intravenous anesthesia group was significantly higher （ t = 3.92, P 〈 0. 05）. Conclusion Intravenous anesthesia and inhalation anesthesia can maintain the stable hemodynamics in intracranial aneurysm emboli- zation, and the recovery is better with intravenous anesthesia. It is worth to be popularized and applied.