舒芬太尼复合异丙酚靶控输注全凭静脉麻醉用于神经外科手术的临床研究

中国临床药理学与治疗学 ›› 2009, Vol. 14 ›› Issue (5): 572-576.

舒芬太尼复合异丙酚靶控输注全凭静脉麻醉用于神经外科手术的临床研究

金立达, 蒋柳明, 赵喜越, 林丽娜

温州医学院第一附属医院麻醉科, 温州325000, 浙江

收稿日期:2008-12-18 修回日期:2009-05-20 发布日期:2020-11-09
通讯作者: 林丽娜, 女, 主任医师, 教授, 硕士生导师, 研究方向:麻醉与器官保护。Tel:13587688101 E-mail:wzlinlina @tom. com
作者简介:金立达, 男, 医学硕士, 研究方向:麻醉与器官保护。Tel:13567797388 E-mail:superda@163. com
基金资助:
温州市科技局科研基金资助项目(Y20060258)

Clinical study on total intravenous anesthesia with sufentanil-profofol given by target-controlled infusion in neurosurgical operations

JIN Li-da, JIANG Liu-ming, ZHAO Xi-yue, LIN Li-na

Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China

Received:2008-12-18 Revised:2009-05-20 Published:2020-11-09

摘要/Abstract

摘要： 目的:评价舒芬太尼复合异丙酚靶控输注(TCI) 全凭静脉麻醉用于神经外科手术的有效性和安全性, 并与静吸复合麻醉作比较。方法:30例择期行开颅神经外科手术患者, 随机分为静吸复合组(对照组) 和靶控输注组(TCI 组), 每组15例。TCI 组采用异丙酚血浆靶控浓度3 μg/mL、舒芬太尼效应室靶控浓度0. 2 ～ 0. 6 ng/mL 维持麻醉;对照组采用持续吸入1% ～ 2% 异氟醚维持麻醉。连续监测并于麻醉前(T₀)、诱导后(T₁)、气管插管后(T₂)、切头皮(T₃)、锯颅骨(T₄)、切除肿瘤(T₅)、缝头皮(T₆) 及气管拔管后(T₇) 记录脑电双频谱指数(BIS)、平均动脉压(MAP)、心率(HR), 记录麻醉苏醒时间、拔管时间、麻醉不良反应、拔管后即刻和拔管后30 min 的清醒程度(OAAS 评分)及伤口疼痛程度(VRS 评分) 。结果:术中两组患者的BIS 值均明显降低, 维持在40 ～ 60 范围, 两组间差异无统计学意义(P >0. 05) 。对照组MAP、 HR 出现明显波动, TCI 组各时点较平稳, 与对照组比较, 差异有统计学意义(P <0. 05) 。与对照组比较, TCI 组苏醒时间及拔管时间明显降低(P <0. 05), 拔管后即刻OAAS 评分升高, 拔管后30 min VRS 评分降低, 拔管后烦躁及恶心呕吐数减少(均P <0. 05) 。结论:舒芬太尼复合异丙酚TCI 全凭静脉麻醉用于神经外科手术, 具有麻醉效果满意、血液动力学稳定、苏醒及拔管快速、术后平稳、无空气污染等优点。

关键词: 舒芬太尼, 二异丙酚, 靶控输注, 神经外科手术

Abstract: AIM:To evaluate the anesthetic effect and the safety of total intravenous anesthesia (TIVA) with sufentanil-profofol given by target-controlled infusion in neurosurgical operations and to compare with intravenous inhalational anesthesia. METHODS:30 patients scheduled for craniocerebral operations were randomly divided into 2 equal groups: the TCI group (target- controlled infusion anesthesia) and combined IV and inhalation anesthesia (control group). Patients in the TCI group were anesthetized by TIVA with target controlled infusion of sufentanil (0. 2-0. 6 ng/mL) and propofol(3 μg/mL). Patients in the control group were given disconnected IV injections of vecuronium bromide combined with inhalation of 1% -2% isoflurance. The spectral index (BIS), mean arterial blood pressure (MAP) and heart rate (HR) of the patients were recorded at eight time points:before induction (T₀), after induction (T₁), after tracheal intubation (T₂), scalp incision(T₃), skull opening (T₄), tumor resection(T₅), scalp closure (T₆), extubation (T₇). Recording the awakening time, extubation time, anesthesia adverse reaction, degree of vigilance (OAAS scores) and pain degree(VRS scores) immediately and 30 min after extubation. RESULTS:The values of BIS in patients of both groups were significantly decreased after the induction of anesthesia and were maintained among 40 to 60, there were no significant differences between two groups(P >0. 05). At the T1, T3, T4, T7 time point, changes of the MAP and HR were more stable in TCI group than those in control group. The awakening time and extubation time in TCI group was obviously shorter in than that in control group. The OAAS scores after extubation were higher and the VRS scores 30 min after extubation were lower in TCI group than those in control group (P <0. 05). The occurrences of postoperative nausea, vomiting and restlessness were more frequently observed in patients in the control group than those in the TCI group. CONCLUSION:Target controlled infusion with sufentanil and propofol for TIVA has advantages of stability in hemodynamics, rapid recovery, less complications, no air pollution and is suitable for neurosurgical operation.

Key words: sufentanil, propofoll, target controlled infusion, neurosurgical operation

中图分类号:

R614

金立达, 蒋柳明, 赵喜越, 林丽娜. 舒芬太尼复合异丙酚靶控输注全凭静脉麻醉用于神经外科手术的临床研究[J]. 中国临床药理学与治疗学, 2009, 14(5): 572-576.

JIN Li-da, JIANG Liu-ming, ZHAO Xi-yue, LIN Li-na. Clinical study on total intravenous anesthesia with sufentanil-profofol given by target-controlled infusion in neurosurgical operations[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2009, 14(5): 572-576.

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