低阿片静吸复合全麻在颅内动脉瘤栓塞术的蛛网膜下腔出血老年患者中的效果观察

Observation on the effect of low opioid intravenous inhalation combined with general anesthesia in elderly patients with subarachnoid hemorrhage undergoing intracranial aneurysm embolization

目的探讨低阿片静吸复合全麻在行动脉瘤栓塞术的蛛网膜下腔出血老年患者的效果。方法选取2019年11月至2020年5月首都医科大学宣武医院行动脉瘤栓塞术的蛛网膜下腔出血老年患者60例,随机分为低阿片静吸复合全麻组(L组)和常规静脉全麻组(V组),每组30例。比较两组患者入室(T0)、麻醉诱导后3 min(T1)、置入喉罩时(T2)、拔管后1 min(T3)的有创MAP及HR的变化,血管活性药物应用剂量,停止麻醉药物输注后自主呼吸恢复时长(t1)、睁眼时长(t2)、依照指令运动时长(t3)、拔管时长(t4),拮抗药物使用剂量及苏醒质量。结果60例患者中男31例,女29例;平均年龄(70.9±1.2)岁。与V组相比,T1时点L组MAP和HR较高[(91.37±13.72)mmHg比(76.87±16.21)mmHg,1 mmHg=0.133 kPa]和HR[(64.57±6.64)次/min比(53.04±9.57)次/min];T3时点L组的MAP和HR较低[(97.81±11.92)mmHg比(106.73±9.40)mmHg]和HR[(69.82±8.81)次/min比(76.47±12.52)次/min];L组去甲肾上腺素[(1.04±0.34)μg/kg比(6.96±0.73)μg/kg]、阿托品[(0.09±0.05)mg比(0.48±0.13)mg]和艾司洛尔[(14.67±6.79)mg比(26.60±11.46)mg]用量较低;L组苏醒时长t1[(4.25±1.23)min比(10.96±3.47)min]、t2[(5.74±1.75)min比(12.37±4.19)min]、t3[(5.86±0.98)min比(13.56±3.58)min]、t4[(8.56±4.37)min比(16.74±5.68)min]均较少;L组新斯的明药物更低[0 mg比(1.57±2.37)mg];L组发生躁动、呼吸抑制及恶心呕吐的发生率和Ramsay评分较低,以上差异均有统计学意义(P<0.05)。结论与常规静脉全麻相比,低阿片静吸复合全麻在脑动脉瘤栓塞术的老年患者中血流动力学更为平稳,血管活性药物用量更少,苏醒质量更佳,更具优势。

Objective To explore the effect of low opioid intravenous inhalation combined with general anesthesia on elderly patients with subarachnoid hemorrhage undergoing aneurysm embolization.Methods A total of 60 elderly patients with subarachnoid hemorrhage who underwent aneurysm embolization in Xuanwu Hospital of Capital Medical University from November 2019 to May 2020 were selected,and were randomly divided into low opioid intravenous inhalation combined with general anesthesia group(group L)and conventional intravenous anesthesia group(group V),with 30 patients in each group.The changes of invasive MAP and HR at the time of entering operating room(T0),3 min after anesthesia induction(tl),inserting laryngeal mask(T2)and 1 min after extubation(T3),and the dosage of vasoactive drugs,the recovery time of spontaneous breathing(tl),the time of opening eyes(t2),the time of exercising according to instructions(t3)and the time of extubation(t4)after stopping the infusion of anesthetic drugs,and the dosage of antagonistic drugs,the awakening quality were compared between the two groups.Results There were 31 males and 29 females among the 60 patients,the mean age was(70.9±1.2)years.Compared with group V,MAP and HR were higher in group L[(91.37±13.72)mmHg vs.(76.87±16.21)mmHg,1 mmHg=0.133 kPa],(64.57±6.64)times/min vs.(53.04±9.57)times/min at T1,and MAP and HR in group L were lower[(97.81±11.92)mmHg vs.(106.73±9.40)mmHg,(69.82±8.81)times/min vs.(76.47±12.52)times/min]at T3.In group L,the dosage of norepinephrine[(1.04±0.34)μg/kg vs.(6.96±0.73)μg/kg],atropine[(0.09±0.05)mg vs.(0.48±0.13)mg],and esmolol[(14.67±6.79)mg vs.(26.60±11.46)mg]were lower than those of group V.The recovery time of group L was t1[(4.25±1.23)min vs.(10.96±3.47)min],t2[(5.74±1.75)min vs.(12.37±4.19)min],and t3[(5.86±0.98)min vs.(13.56±3.58)min],t4[(8.56±4.37)min vs.(16.74±5.68)min).Neostigmine dosage in group L was lower than that in group L[0 mg vs.(1.57±2.37)mg].The incidence of agitation,respiratory depression,nausea and vomitingand Ramsay score in group L were lower than those in group V,the differences were statistically significant(all P<0.05).Conclusions Compared with conventional intravenous general anesthesia,low opioid intravenous inhalation combined general anesthesia has more stable hemodynamics,less dosage of vasoactive drugs,better quality of recovery in elderly patients undergoing cerebral aneurysm embolization.