摘要
目的比较环泊酚和丙泊酚在经鼻内镜垂体瘤切除术中的麻醉效果。方法选择美国麻醉医师协会(ASA)分级ⅠⅡ级择期行经鼻内镜下垂体瘤切除术的患者176例,随机分为环泊酚组(H组)和丙泊酚组(C组),每组88例患者。麻醉诱导时采用咪达唑仑0.04 mg/kg,舒芬太尼0.25μg/kg,环泊酚0.4 mg/kg(H组)或丙泊酚1.5 mg/kg(C组),顺苯磺酸阿曲库铵0.15 mg/kg。麻醉维持:H组泵注环泊酚0.8 mg·kg^(-1)·h^(-1),C组泵注丙泊酚5 mg·kg^(-1)·h^(-1),两组均持续泵注瑞芬太尼0.25μg·kg^(-1)·min^(-1),顺式阿曲库铵2μg·kg^(-1)·min^(-1)。术中调整泵注速度使脑电双频指数(BIS)维持在40~60之间。观察入室后(T_(0))、诱导后(T_(1))、插管后(T_(2))、肾上腺素棉片处理鼻腔(T_(3))、手术结束(T_(4))、苏醒时(T_(5))的平均动脉压(MAP)和心率(HR)的变化,记录麻醉诱导时间、苏醒时间、拔管时间、拔管后Ramsay镇静评分;记录不良反应如诱导后低血压、肾上腺素棉片处理后高血压、注射痛、苏醒后呛咳、躁动和恶心呕吐等的发生率。结果与T_(0)时比较,两组患者的MAP在T_(1)和T_(4)时降低,T_(3)时明显升高;HR在T_(2)、T_(3)时加快,T_(4)时减慢,差异有统计学意义(P<0.05)。与C组比较,H组患者的MAP在T_(1)时降低幅度和T_(3)时升高幅度均较小,差异有统计学意义(P<0.05)。H组麻醉诱导时间明显短于C组,差异有统计学意义(P<0.05)。H组患者诱导后低血压、注射痛、肾上腺素棉片处理后的高血压以及苏醒期呛咳的发生率低于C组,差异有统计学意义(P<0.05)。结论环泊酚和丙泊酚均可用于经鼻内镜垂体瘤切除术,环泊酚具有良好的镇静效果,术中血流动力学变化更趋平稳,术后不良反应发生率低。
Objective To compare the anesthetic effects of propofol and ciprofol in endoscopic nasal pituitary tumor resection.Methods 176 patients in the American Society of Anesthesiologists(ASA)gradingⅠtoⅡfor elective endoscopic pituitary adenoma resection were randomly divided into two groups:the cyclophorol group(H group)and the propofol group(C group),with 88 patients in each group.During anesthesia induction,patients were given with midazolam 0.04 mg/kg,sufentanil 0.25μg/kg,atracurium cisphenylate 0.15 mg/kg combine with ciprofol 0.4 mg/kg(group H)or propofol 1.5 mg/kg(group C).During anesthesia maintenance,all patients were maintained with ciprofol 0.8 mg·kg^(-1)·h^(-1)(group H)or propofol 5 mg·kg^(-1)·h^(-1)(group C)combined with remifentanil 0.25μg·kg^(-1)·min^(-1)and atracurium cisphenylate 2μg·kg^(-1)·min^(-1).The bispectral index(BIS)was maintained between 40 and 60 by adjusting the pumping speed during the operation.The changes of mean arterial pressure(MAP)and heart rate(HR)after entering the room(T_(0)),induction(T_(1)),intubation(T_(2)),treatment of nasal cavity with epinephrine sponge(T_(3)),end of operation(T_(4))and at awakeing(T_(5))were observed.The anesthesia induction time,awakening time,extubation time and Ramsay sedation score after extubation were recorded.And the incidence of adverse reactions such as post-induced hypotension,hypertension after epinephrine cotton treatment,injection pain,cough,restless,nausea and vomiting were recorded.Results Compared with T_(0),the MAP decreased at T_(1)and T_(4),and significantly increased at T_(3).HR accelerates at T_(2)and T_(3),and slows down at T_(4)and the difference was statistically significant(P<0.05).Compared with group C,the MAP of group H decreased slightly at T_(1)and increased slightly at T_(3)and the difference was statistically significant(P<0.05).The induction of anesthesia in the group H was significantly faster than that in the group C(P<0.05).The incidence of post-induced hypotension,hypertension after epinephrine cotton treatment,injection pain and cough in the group H was lower than that in the group C(P<0.05).Conclusions Ciprofol and propofol can be used for endoscopic nasal pituitary tumor resection.Ciprofol has a good sedative effect,with more stable hemodynamic changes during surgery,and a lower incidence of postoperative adverse reactions.
作者
梅凤美
杨坤
吴姗姗
金晶星
陆军
王宁
曾琼
MEI Fengmei;YANG Kun;WU Shanshan(Department of Anesthesiology,The Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《临床神经外科杂志》
2023年第5期531-535,共5页
Journal of Clinical Neurosurgery
基金
南京市医学科技发展项目(YKK17133)。
关键词
环泊酚
丙泊酚
内镜
垂体瘤
ciprofol
propofol
endoscope
pituitary tumor