摘要
目的 观察瑞芬太尼复合丙泊酚在清醒开颅手术中的应用,探讨其可行性、安全性和患者的满意度.方法 回顾性研究昆明医科大学第二附属医院从201 1年8月至2013年12月,14例语言运动区的脑胶质瘤患者在麻醉-清醒-麻醉（Asleep-awake-asleep）下开颅手术切除肿瘤.用0.2％罗哌卡因于头钉处和手术切口行局部浸润麻醉.术中以微量泵持续静脉输注瑞芬太尼0.03- 0.05 μg/（kg·min）.丙泊酚75 - 100 μg/（kg·min）.从局部浸润麻醉开始,让患者处于麻醉-清醒-麻醉过程.术中功能区监测采用连续计数法,直到肿瘤完整切除.术中监测血流动力学（血压、心率）、氧饱和度、呼吸、呼气末C02、动脉血气分析和并发症,并记录术中和术后患者的满意度.结果 患者均能在清醒状态下完成肿瘤切除术,术中血流动力学稳定,未见明显的并发症,镇静评分为（3±0.4）级;所有患者疼痛评分均低于4分.术中血气分析结果未发现低氧血症、高碳酸血症及酸碱平衡紊乱,患者和术者的满意度良好.平均满意度评分（93.6±0.2）分,95％CI为100％.结论 在局部浸润麻醉的基础上,根据患者的麻醉深度适当调整瑞芬太尼和丙泊酚的量,可完成清醒开颅功能区肿瘤切除术,减少脑部重要功能区的损害.减少术后并发症,提高患者的生活质量.
Objective To investigate the availability,safety,and patient＇s satisfaction of propofolremifentanil application in awake craniotomy surgery.Methods We retrospectively reviewed 14 cases of gliomas in eloquent cortex from August 2011 to December 2013.14 cases of gliomas in eloquent cortex were resected undergoing craniotomy in awaking anesthesia （Asleep-awake-asleep）.The enrolled patients included 5 cases of male,and 9 cases of female,the age was 42 - 59,ASA Ⅰ-Ⅱ.All of patients underwent preoperative CT,MRI scan and enhanced scan.Imaging findings showed language function glioma （including 8 cases of adjacent Broca＇s area,and 6 cases in nearby Wernicke＇s area）,postoperative pathological results certified the diagnosis.All patients were anesthetized with 0.2％ Ropivacaine in nail place and surgical incision line.And Remifentanil 0.03-0.05 ug/（kg·min） and Propofol in 75-100 ug/（kg·min） were injected intravenously with micropump.From local infiltration anesthesia till the completion of craniotomy,we kept patients in sleep state with infusion drugs of high dosage.We kept patients in awake state with reduction of intravenous drugs gradually until removal of the tumor.We communicate with patients constantly,language cortex localization were monitored using continuous number counting during removal of the tumor.The patients slept again with deepen anesthesia until the end of the surgery.The patients were monitored during operation,including changes of hemodynamics,Spo2,PetCO2,blood gas analysis,the complications and the satisfaction for surgical procedure was evaluated.Results All patients underwent in surgery conscious state with stable hemodynamics.There were no conspicuous complications,sedation score was （3 ± 0.4）.Pain score of all of patients was below 4 points.There was no hypoxemia,hypercapnia,and acid-base balance disorders during operation,satisfaction rate of patients and surgeon was well.Conclusion Remifentanil and propofol can be used securely in awake craniotomy surgery on the basis of local infiltration anesthesia,and under appropriate adjustments intravenous amount of remifentanil and propofol,and can reduce postoperative complications and improve the patient＇s quality of life.
出处
《昆明医科大学学报》
CAS
2014年第6期55-57,80,共4页
Journal of Kunming Medical University
基金
云南省中青年学术技术带头人后备人才基金资助项目(2009CI034)
关键词
瑞芬太尼
丙泊酚
清醒麻醉
开颅
Remifentanil
Propofol
Awake anesthesia
Craniotomy
