喉罩通气下瑞芬太尼复合丙泊酚全凭静脉麻醉在颅内动脉瘤血管介入治疗术中的应用

目的 比较在瑞芬太尼复合丙泊酚全凭静脉麻醉下喉罩通气和气管插管用于颅内动脉瘤血管介入治疗术对患者血流动力学的影响.方法 40例美国麻醉医师学会(ASA)Ⅰ～Ⅱ级在全身麻醉下实施颅内动脉瘤血管介入治疗术的患者,完全随机分为喉罩组和气管插管组.比较2组麻醉诱导前(T0)、插入喉罩/气管导管前(T1)、插入喉罩/气管导管后即刻(T2)、插入喉罩/气管导管后5 min(T3)、10 min(T4)、手术开始时(T5)和拔除喉罩/气管导管后即刻(T6)的SBP、DBP、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2).结果 T2时气管插管组SBP、DBP、HR分别为(144.1±41.8)mm Hg(1 mm Hg=0.133 kPa)、(89.3±12.5)mm Hg、(92.3±12.2)次/min]显著高于喉罩组分别为(106.3±18.6)mm Hg、(63.1±9.2)mm Hg、(71.4±9.2)次/min],差异均有统计学意义(均P＜0.01).结论 喉罩通气下瑞芬太尼复合丙泊酚全凭静脉麻醉用于颅内动脉瘤血管介入治疗术能使麻醉诱导平稳,术中血流动力学的稳定,术后苏醒快,是一种理想的麻醉方法.

Abstract：

Objective To compare the hemodynamic effects of remifentanil and propofol during total intravenous anesthesia with laryngeal mask airway and tracheal intubation for the operation of endovascular embolization in intracranial aneurysms. Methods Forty cases of American society of Anesthesiologists (ASA) Ⅰ～Ⅱ grade under general anesthesia in intracranial aneurysm patients undergoing interventional treatment were randomly divided into the laryngeal mask airway(LMA) group and tracheal intubation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (PET CO2) were recorded at 7 time points. Results In intubation group,SBP,DBP,HR(144. 1 ±41.8)mm Hg, (89.3 ±12.5)mm Hg, (92.3 ± 12.2)times/min, respectively] were significantly higher than those in the LMA group (106.3±18.6)mm Hg, (63. 1 ±9.2)mm Hg, (71.4 ±9. 2)times/min,respectivel] after intubation(P ＜0.01).Conclusions Laryngeal mask ventilation with remifentanil and propofol total intravenous anesthesia is a good anesthesia for intracranial aneurysms interventional therapy. This anesthesia method can guarantee a smooth induction of anesthesia, hemodynamic stability and rapid recovery after surgery.

Application of laryngeal mask ventilation combined with remifentanil and propofol during total intravenous anesthesia in intracranial aneurysm intervention

Objective To compare the hemodynamic effects of remifentanil and propofol during total intravenous anesthesia with laryngeal mask airway and tracheal intubation for the operation of endovascular embolization in intracranial aneurysms. Methods Forty cases of American society of Anesthesiologists (ASA) Ⅰ～Ⅱ grade under general anesthesia in intracranial aneurysm patients undergoing interventional treatment were randomly divided into the laryngeal mask airway(LMA) group and tracheal intubation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO2), end-tidal carbon dioxide partial pressure (PET CO2) were recorded at 7 time points. Results In intubation group,SBP,DBP,HR(144. 1 ±41.8)mm Hg, (89.3 ±12.5)mm Hg, (92.3 ± 12.2)times/min, respectively] were significantly higher than those in the LMA group (106.3±18.6)mm Hg, (63. 1 ±9.2)mm Hg, (71.4 ±9. 2)times/min,respectivel] after intubation(P ＜0.01).Conclusions Laryngeal mask ventilation with remifentanil and propofol total intravenous anesthesia is a good anesthesia for intracranial aneurysms interventional therapy. This anesthesia method can guarantee a smooth induction of anesthesia, hemodynamic stability and rapid recovery after surgery.