运动障碍性疾病脑深部电刺激术麻醉特点分析

目的观察分析不同麻醉方法用于各种运动障碍性疾病患者脑深部电刺激术的优劣及麻醉管理特点。方法以365例行脑深部电刺激术的运动障碍性疾病患者（年龄〉60岁者154例占42．19％、ASAⅢ级患者60例占16．44％）作为观察对象，术中麻醉分别采用局部麻醉复合神经安定镇痛、局部麻醉复合静脉麻醉、气管内插管全身麻醉和喉罩静脉全身麻醉方式，记录术中麻醉并发症发生率。结果手术过程分析显示，局部麻醉复合神经安定镇痛组和局部麻醉复合静脉麻醉组患者呼吸抑制发生率较高，分别为17．65％（3／17）和22．45％（11／49），明显高于其他两种麻醉方式（0／44、0／255）；而气管内插管全身麻醉组并发症则以血压降低29．55％（13／44）]或升高13．64％（6／44）]为主要表现，且显著高于喉罩静脉全身麻醉组血压降低者：8．24％（21／255）、升高0．78％（2／255）]，组间差异具有统计学意义（×。=16．909，P=0．000；x^2=19．123，P=0．000）。结论运动障碍性疾病患者病情复杂，应结合术前全身状态、伴发疾病及手术要求等情况选择相应的麻醉方式，其中以喉罩静脉全身麻醉更具优势。

Retrospective analysis of anesthesia for deep brain electrical stimulation in movement disorders

Objective To analyze the merits and demerits, and main points of anesthetic management of different anesthesia regimens for deep brain stimulation （DBS） in movement disorders. Methods Recorded and summarized general information of 365 patients with movement disorders： 1） Local anesthesia combined with hypnoanalgesia： concentration of 1% lidocaine or 0.5% ropivacaine of local infiltration anesthesia, intravenous fentanyl （0.05-0.10 rag） and droperidol （1-2 mg） assisted sedation, analgesia. 2） Local anesthesia combined with intravenous anesthesia： local anesthesia implemented as above, in addition to intravenous fentanyl （0.05-0.10 mg）, propofol 2-4 mg/（kg, h）, midazolam 0.02-0.03 mg/kg. 3） Endotracheal intubation and general anesthesia： local anesthesia first, then anesthesia was induced with midazolam 0.03-0.05 mg/kg, fentanyl 2-3 Ixg/kg, etomidate 0.10-0.20 mg/kg, vecuronium 0.10 mg/kg or rocuronium 0.70 mg/kg. Endotracheal intubation, was performed for mechanical ventilation after implementation. Anesthesia was maintained with continuous intravenous infusion of propofol 2-4 mg/（kg, h） and remifentanil 0.05-0.10 Ix g/（kg, min）. 4） Laryngeal mask anesthesia： firstly local anesthesia was performed as above. Then anesthesia was induced with midazolam 0.02-0.03 mg/kg, fentanyl l-2 Ixg/kg, etomidate 0.10-0.20 mg/kg, vecuronium 0.10 mg/kg or rocuronium 0.70 mg/kg. Anesthesia maintenance was the same as the above. Recorded the incidence of intraoperative complications of four anesthesia regimens for deep brain stimulation. Results For local anesthesia combined with hypnoanalgesia （17.65%, 3/17） and local anesthesia combined with intravenous anesthesia （22.45%, 11/49）, the incidence rate of respiratory depression was higher than the other two anesthesia （0/44, 0/255）. The difference was not significant. The incidence of decreased blood pressure and increased blood pressure was higher in endotracheal intubation and general anesthesia group （29.55% and 13.64% ） than in laryngeal mask anesthesia group （8.24% and 0.78%）. The difference was statistically significant （P = 0.000）. Conclusion The condition of movement disorders patients is usually complex. Appropriate anesthesia regimens should be selected according to individual preoperative condition, concurrent diseases and operation requirements. Laryngeal mask anesthesia for DBS seems to be superior to other anesthesia regimens.