颅内动脉瘤微创栓塞术的麻醉管理

目的探讨不同全麻维持药物用于颅内动脉瘤微创栓塞术的效果。方法回顾性分析2003年1月~2010年3月30例颅内动脉瘤介入栓塞术的临床资料。在全麻下实施颅内动脉瘤微创栓塞术,根据全麻维持药物的不同分为2组：A组（吸入异氟烷）和B组（静脉输注丙泊酚或瑞芬太尼复合吸入异氟烷）,每组15例。结果 A组术中出血量（15±7）ml与B组（12±8）ml无统计学差异（t=1.093,P=0.284）。A、B组尿量分别为（767±285）ml和（738±260）ml,无统计学差异（t=0.291,P=0.773）。A组输液量（1430±391）ml与B组（1367±352）ml无统计学差异（t=0.500,P=0.621）。A、B组拔管时间分别为（10±5）min和（9±5）min,无统计学差异（t=0.479,P=0.637）。2组血管活性药物的应用情况无统计学差异（P〉0.05）。所有患者麻醉诱导、维持和拔管过程中循环系统稳定。2组在麻醉前、插管后1 min、术中50 min、拔管时平均动脉压和心率比较差异无统计学意义（P〉0.05）;2组插管后1 min和术中50 min的平均动脉压和心率与麻醉前比较差异有统计学意义（P〉0.05）,但是变化均在正常生理范围内,这种差异无临床意义。2组各有1例出现脑血管痉挛,无动脉瘤破裂或颅内动脉栓塞等并发症。结论无论吸入异氟烷,还是静脉输注丙泊酚或瑞芬太尼复合吸入异氟烷,均能安全、有效地用于颅内动脉瘤微创栓塞术的全麻维持。

Anesthetic Management of Patients Undergoing Minimally Invasive Coiling for Intracranial Aneurysms

Objective To investigate the efficacy of different maintenance anesthetics in minimally invasive coiling for intracranial aneurysms.Methods A retrospective review was conducted on thirty patients who were diagnosed with intracranial aneurysms from January 2003 to March 2010,and underwent minimally invasive coiling under general anesthesia in our hospital.The patients were divided into two groups according to the drugs used for maintenance of anesthesia： Group A（inhaled isoflurane,n=15） and Group B（intravenous infusion of propofol or remifentanil combined with inhaled isoflurane,n=15）. Results All the patients had stable cardiovascular variables during induction and maintenance of anesthesia and extubation.No significant differences were found between the two groups in intraoperative blood loss （15±7） ml vs.（12±8） ml,t=1.093,P=0.284],urine output （767±285） ml vs.（738±260） ml,t=0.291,P=0.773],volume fluid infusion （1430±391） ml vs.（1367±352） ml,t=0.500,P=0.621],time to extubation （10±5） min vs.（9±5） min,t=0.479,P=0.637],the use of vasoactive agents（P0.05）,and MAP and HR detected pre-anesthesia,1 min after extubation,50th min during the operation,and at the extubation（P0.05）.In both the groups,the MAP and HR changed significantly at 1 min after extubation,and 50th min during the operation,compared to pre-anesthesia,however,the change was within physiologically normal range,and thus had no clinical significance.In each of the groups,there was one case of cerebral vasospasm.No aneurysm rupture or intracranial arterial embolism was found.Conclusion Both inhaled isoflurane and combination of intravenous infusion of propofol or remifentanil with inhaled isoflurane can be safe and effective for anesthesia maintenance in minimally invasive coiling for intracranial aneurysms.