丙泊酚靶控输注和持续泵注对颅脑手术患者颅内压的影响

目的:比较丙泊酚靶控输注和持续泵注对颅脑手术患者颅内压(ICP)的影响。方法:选取择期行颅脑手术患者60例,随机分为2组,每组30例:T组(丙泊酚靶控输注组),麻醉诱导采用丙泊酚4μg·mL-1靶控输注,给予芬太尼3～5μg·kg-1、咪达唑仑0.05mg·kg-1、罗库溴铵0.9mg·kg-1,丙泊酚维持用量为2～3μg·mL-1靶控输注;C组(丙泊酚持续泵注组),丙泊酚诱导剂量为2mg·kg-1,丙泊酚维持量为4～6mg·kg-1·h-1,余同T组。记录2组不同时点的腰部脑脊液压力(CSFP)以及手术结束时丙泊酚使用量。结果:2组患者麻醉诱导前(基础值)CSFP比较无统计学差异(P>0.05);切开硬膜前、切开硬膜后2组患者CSFP均较基础值低,且T组较C组降低更加明显,差异有统计学意义(P<0.05);在关硬膜后和手术结束时2组患者CSFP无统计学差异(P>0.05);T组丙泊酚使用量较C组明显降低(P<0.05)。结论:丙泊酚的靶控输注静脉麻醉在降低颅内压方面的作用优于丙泊酚的持续泵注。

Effects of Propofol Target-controlled Infusion and Continuous Pump Infusion on Intracranial Pressure in Patients Underwent Craniocerebral Operation

OBJECTIVE： To compare the effects of propofol target-controlled infusion vs. continuous pump infusion on intracranial pressure （ICP） in patients underwent craniocerebral operation. METHODS： 60 patients with scheduled for elective craniocerebral operation were divided into two groups （n=30） ： propofol target-controlled infusion group （group T）, propofol continuous pump infusion group （group C）. In group T, anesthesia was induced with 4 ug·mL^-1 target-controlled infusion of propofol, 3-5 μg·kg^-1 fentanyl, 0.05 mg·kg^-1 midazolam, and 0.9 mg·kg^-1 rocuronium and maintained with 2-3 ug·mL^-1 target-controlled infusion of propofol. In group C, anesthesia was induced with 2 mg·kg^-1 propofol and other inducers which were similar to that in group T and maintained with 4-6 mg·kg^-1·h^-1 target-controlled infusion of propofol. C SFP was recorded at different time points as well as the total dose of propofol in each case. RESULTS： The CSFP of two groups had no significant differences before inducement of anesthesia （baseline value） （P〉0.05）. The CSFP before and after opening dura mater was obviously lower than the baseline value （P〈0.05）. As compared with group C, the CSFP was significantly descreased in group T （P〈0.05）. There was no statistically significance in the CSFP after closing dura mater and at the end of the operation （P〉0.05）. The total dose of propofol in group T was smaller than in group C. CONCLUSION： Target controlled infusion of propofol is better than continuous pump injection in lowering the ICP during neurological surgery.