异氟醚麻醉复合异丙酚控制性降压用于神经内镜手术的临床观察

Effect of controlled hypotension with combination of isoflurane and propofol on neuroendoscopic operation

目的 观察异氟醚麻醉复合异丙酚控制性降压用于神经内镜手术的临床效果。方法 30例病患者在吸入异氟醚 0 .6～ 1.0MAC基础上 ,同时静注异丙酚 6～ 10mg/ (kg·h) ,需要降压时 ,加快异丙酚输入速率至 30～ 4 0mg/ (kg·h) ,当MAP降至 8.5～ 11KPa时 ,再减慢异丙酚的输入速率至 4～ 10mg/ (kg·h) ,以维持适宜的低血压水平 ,同时监测降压期间的HR、CVP、PETCO2 、SpO2 及停药后各参数的情况。结果 加快输入异丙酚在 4 .5± 0 .5min内 ,MAP达到所需的控制性低血压水平 ,减慢异丙酚输入速率后能维持适宜的低血压水平 ,停用异丙酚 5 .5± 0 .5min血压可自动恢复到降压前的水平 ,无“反跳”现象。降压期间HR、CVP、SpO2 、PETCO2 和ECG均无明显异常。结论 异氟醚麻醉复合异丙酚用于神经内镜手术时控制性降压 ,可发挥两药的协同作用 ,增加降压效果亦有脑保护作用 ,是一种操作简单、易于调节。

Objective: To observe the effects of controlled hypotension with combination of isoflurane and propofol for neuroendoscope operation.Methods:Thirty patients were anesthetized with isoflurane inhalation (0.6～1.0) % combined with propofol 6～10 mg / (kg · h). when controlled hypotension was reguired the rate of propofol was increased to 30～40 mg/(kg · h), MAP escended to 8.5～11 KPa and when decreasing the rate of propofol to 4～10 mg/(kg·h) MAP was maintained within this range, during controlled hypotension and blood pressure recovery, HR, CVP,PETCO 2, SpO 2 were monitored.Results:(4.5±0.5) min after increasing the rate of propofol infusion the mean arterial pressure reached the degree of controlled hypotension, and when decreasing the rate of propofol, MAP was maintained the degree of hypotension,(5.5±0.5)min after withdrawal of propofol administration MAP recovered. No rebounding response was observed . During controlled hypotension HR, CVP, SpO 2, PETCO 2 and ECG showed no significant change. Conclusions: Combination of isoflurane and propofol for controlled hypotension is an symplastie effective method which is rapid and easy to control and protect cerebrum.