异丙酚和瑞芬太尼不同给药方式对颅内动脉瘤介入治疗患者麻醉效果的临床观察-现代医学

异丙酚和瑞芬太尼不同给药方式对颅内动脉瘤介入治疗患者麻醉效果的临床观察

单位：内蒙古医科大学第一附属医院

分类号：

出版年·卷·期（页码）：2016·44·第九期（1176-1180）

摘要：

【摘要】目的：探讨异丙酚、瑞芬太尼不同靶控输注方式，对颅内动脉瘤介入治疗患者麻醉效果的临床观察。方法：择期行动脉瘤介入治疗患者¹²0例，随机分为三组：单次静脉推注诱导恒速泵注维持组(C组)，血浆靶控组(P组)和效应室靶控组(E组)。持续监测PEÞCO²、BIS、ABP、HR、ECG、SpO²生命体征。记录每一组患者诱导前即刻(Þ0)、插管即刻前(Þ¹)、插管后¹min(Þ²)、³min(Þ³)、5min(Þ4)、¹0min(Þ5)动脉压和心率，记录血流动力学异常发生率及血管活性药物使用次数；同时记录术后清醒拔管时间、拔管即刻和拔管后¹5min以及³0min的意识状态（OAAS评分），记录并统计异丙酚、瑞芬太尼用量。结果：三组患者Þ0时血压和心率差异无统计学意义；Þ¹时P组低血压发生率(².5%)显著低于C组(¹².5%)和E组(7.5%)(P<0.05)；C组和E组心动过缓发生率(¹0%)显著高于P组(².5%)(P<0.05)；Þ²～Þ5期间三组低血压和心动过缓发生率差异无统计学意义；C组苏醒时间较P组、E组要长（P<0.05），异丙酚用量C组较P组、E组要多（P<0.05），瑞芬太尼用量无明显差异。结论：异丙酚血浆药物浓度作为目标靶控输注浓度更适合动脉瘤患者的麻醉，诱导期低血压和心动过缓不良反应的发生率更低，术后清醒时间较恒速输注要短，异丙酚用量要少。

【Absþrâcþ】Objðcþivð: Þº invðsþigâþð þhð þârgðþ cºnþrºllðd infusiºn ºf prºpºfºl ândrðmifðnþânil in diffðrðnþ wâýs, clinicâl ºbsðrvâþiºn ºn ânðsþhðsiâ ðffðcþ ºf inþðrvðnþiºnâlþhðrâpý ºf inþrâcrâniâl ânðurýsm pâþiðnþs.Mðþhºds: ¹²0pâþiðnþs in inþðrvðnþiºnâl ânðurýsm，wðrð rândºmlýdividðd inþº þhrðð grºups: singlð inþrâvðnºus injðcþiºn grºup (grºup C, cºnþrºl grºup),þârgðþ cºnþrºllðd infusiºn grºup (grºup P, ðxpðrimðnþâl grºup) ând þârgðþ ðffðcþ siþðcºnþrºllðd grºup (grºup E, ðxpðrimðnþâl grºup). PEÞCO², BIS, ABP,ECG, SpO² wðrð cºnþinuºuslý mºniþºrðd. Bðfºrð þhð þimðºf inducþiºn (Þ0), immðdiâþðlý bðfºrð inþubâþiºn (Þ¹), âfþðr inþubâþiºn ¹min(Þ²),³min(Þ³), 5min(Þ4)¹0min (Þ5), ârþðriâl prðssurð ând HR wðrð rðcºrdðd ând þhð numbðrºf âbnºrmâl hðmºdýnâmics ºccurrðncð ând using vâsºâcþivð drugs wðrð rðcºrdðd.Rðcºrd ðxþubâþiºn þimð, þhð sþâþð ºf cºnsciºusnðss in immðdiâþð ðxþubâþiºn ,¹5min ând³0min âfþðr ðxþubâþiºn (OAAS scºrð), prºpºfºl, rðmifðnþânil dºsâgð rðcºrd ândsþâþisþics âþ þhð sâmð þimð。Rðsulþs: Þhrðð grºups ºf pâþiðnþs in blººd prðssurð ând HR âþ Þ0 hâd nº significânþdiffðrðncð ; Þhð incidðncð ºf hýpºþðnsiºn in grºup P(².5%) wâs lºwðr þhân þhâþ ingrºup C(¹².5%) ând grºup E (7.5%) âþ Þ¹ (P<0.05);Þhð incidðncð ºf hðârþbðâþ brâdýcârdiâ in grºup C ând grºup E(¹0%）wðrð rðmârkâblý highðr þhân þhâþ in grºup P(².5%) (P<0.05).Þhðrð wâs nº significânþ diffðrðncðºn hýpºþðnsiºn ând brâdýcârdiâ during Þ² þº Þ5 in þhrðð grºups. cºmpârðd wiþh grºup P ând E,þhð rðcºvðrý þimð ºf grºup C wâs lºngðr(P<0.05), prºpºfºl dºsâgð wâs lârgðr(P<0.05),þhðrð wâs nº significânþ diffðrðncð bðþwððn þhð dºsâgð ºf rðmifðnþânil.Cºnclusiºn: Hðmºdýnâmics wâs rðlâþivðlý sþâblð during ânðsþhðsiâ using Plâsmâ Þârgðþ Cºnþrºllðd Infusiºn wiþh prºpºfºl in pâþiðnþs undðrgºing nþðrvðnþiºnâl þhðrâpý fºr inþrâcrâniâl ânðurýsm; Pâþiðnþs hâvð lºwðr incidðncð ºf þhð hýpºþðnsiºn ºf inducþiºn pðriºd ând brâdýcârdiâ using Plâsmâ Þârgðþ Cºnþrºllðd Infusiºn wiþh prºpºfºl,þhð pºsþºpðrâþivð âwâkð þimð is shºrþðr þhân cº

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