雷米芬太尼在清醒状态下切除脑功能区肿瘤的临床应用

目的 探讨雷米芬太尼在清醒状态下切除脑功能区肿瘤的临床应用.方法 24例脑功能区肿瘤患者,ASA分级Ⅱ～Ⅲ级;采用机械抽样法随机分为对照组和雷米芬太尼组,每组12例.全部患者以0.2%罗哌卡因沿切口行局部浸润麻醉.雷米芬太尼组术中以微量泵持续静脉注射雷米芬太尼0.05～0.10μg/(kg·min),根据手术需要作适当调整;对照组术中以0.9%氯化钠代替雷米芬太尼.两组均保持术中患者意识清醒,监测术中血流动力学变化和并发症情况,记录术后患者对手术过程的满意度.结果 两组患者均能在清醒状态下配合完成手术,雷米芬太尼组的平均动脉压和心率在开颅、颅内手术期、关颅时点均明显低于对照组(P<0.05),未见明显呼吸抑制、恶心呕吐、烦躁不安等并发症,雷米芬太尼组术后满意度评分为(3.3±0.6)分,明显高于对照组的(2.4±0.5)分,差异有统计学意义(p<0.05).结论 在局部麻醉切除脑功能区肿瘤时合理应用雷米芬太尼,可使患者血流动力学稳定,且手术耐受性良好.

Abstract：

Objective To investigate the clinical application of remifentanil in awake state for removal of tumors in functional brain area. Methods Twenty-four patients with tumors in functional brain area were divided into two groups by random digits table with 12 cases each:control group and remifentanil group. Infiltration anesthesia was used in all patients with 0.2% ropivacaine. Remifentanil was injected intravenously with micropump in 0.05-0.10 μg/ (kg·min) in remifentanil group and 0.9% sodium chloride was instead of remifentanil in control group. Patients remained awake during surgery in both groups. The hemodynamic changes and complications during operation were monitored. The satisfaction for surgical procedure was evaluated. Results The patients in two groups could be completed in awake state with surgery;mean artery pressure, heart rate in remifentanil group during opening or closing skull or intracranial period were significantly higher than those in control group(P< 0.05). There were no conspicuous complication in two groups such as respiratory depression, nausea, vomitting and dysphoria. The satisfaction score in remifentanil group[(3.3 ?0.6) scores] was higher than that in control group[(2.4 ?0.5) scores],there was significant difference between two groups (P<0.05). Conclusion Awake brain tumor surgery could be completed in rational use of remifentanil on the base of good local anesthesia, and hemodynamics are stable and the patients are well tolerated.

Clinical application of remifentanil in awake state for removal of tumors in functional brain area

Objective To investigate the clinical application of remifentanil in awake state for removal of tumors in functional brain area. Methods Twenty-four patients with tumors in functional brain area were divided into two groups by random digits table with 12 cases each:control group and remifentanil group. Infiltration anesthesia was used in all patients with 0.2% ropivacaine. Remifentanil was injected intravenously with micropump in 0.05-0.10 μg/ (kg·min) in remifentanil group and 0.9% sodium chloride was instead of remifentanil in control group. Patients remained awake during surgery in both groups. The hemodynamic changes and complications during operation were monitored. The satisfaction for surgical procedure was evaluated. Results The patients in two groups could be completed in awake state with surgery;mean artery pressure, heart rate in remifentanil group during opening or closing skull or intracranial period were significantly higher than those in control group(P< 0.05). There were no conspicuous complication in two groups such as respiratory depression, nausea, vomitting and dysphoria. The satisfaction score in remifentanil group[(3.3 ?0.6) scores] was higher than that in control group[(2.4 ?0.5) scores],there was significant difference between two groups (P<0.05). Conclusion Awake brain tumor surgery could be completed in rational use of remifentanil on the base of good local anesthesia, and hemodynamics are stable and the patients are well tolerated.