Bai Nianyue, Guo Qulian, Cheng Zhigang, Wang Yueling, Yang Shenghui
Department of Anesthesiology, Xiangya Hospital, Central South University,Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009 Jan;34(1):59-62.
To compare the hemodynamics and post-anesthetic recovery of total intravenous anesthesia (TIVA) with remifentanil or fentanyl combined with propofol administered by target controlled infusion (TCI) in neurosurgery.
A total of 80 patients undergoing selective neurosurgery were randomly divided into a remifentanil group (Group R, n=40) and a fentanyl group (Group F, n=40). In Group R,remifentanil and propofol was administered by TCI and the blood concentration were 3 approximately 5 microg/L and 3 approximately 5 mg/L each. In Group F, fentanyl was continuously infused at 2 approximately 3 microg/(kg.h) and propofol was administered by TCI with the same blood concentration as that in Group R.Vecuronium was injected at intervals to maintain muscle relaxant.Mean arterial pressure and heart rate during the anesthesia and post-anesthetic recovery were recorded.
Mean arterial pressure of all the patients was decreased significantly from induction of anesthesia to termination of operation compared with that before the induction( P<0.01). The heart rate of Group R was increased obviously from recovery of respiration to extubation and heart rate of Group F was decreased obviously from fixed headframe to termination of operation compared with that before the induction (P<0.01). But there was no significant difference between the 2 groups (P>0.05). The eyes opened and extubed time of Group R were decurtated obviously and the scores of pain were increased significantly (P<0.01).
TIVA with remifentanil or fentanyl combined with propofol administered by TCI in neurosurgical operation can provided steadible hemodynamics. Resuscitation of remifentanil with propofol administered by target controlled infusion were more quickly but the scores of pain were more higher than that of fentanyl.
比较在神经外科手术中，瑞芬太尼或芬太尼联合丙泊酚靶控输注（TCI）全静脉麻醉（TIVA）的血流动力学及麻醉后恢复情况。
80例行择期神经外科手术的患者随机分为瑞芬太尼组（R组，n = 40）和芬太尼组（F组，n = 40）。R组采用TCI输注瑞芬太尼和丙泊酚，血药浓度分别为3～5μg/L和3～5mg/L。F组以2～3μg/（kg·h）持续输注芬太尼，丙泊酚TCI输注，血药浓度同R组。间断注射维库溴铵维持肌肉松弛。记录麻醉期间及麻醉后恢复过程中的平均动脉压和心率。
与麻醉诱导前比较，所有患者从麻醉诱导至手术结束平均动脉压均显著降低（P<0.01）。与麻醉诱导前比较，R组从呼吸恢复至拔管时心率明显增快，F组从固定头架至手术结束时心率明显减慢（P<0.01）。但两组间比较差异无统计学意义（P>0.05）。R组睁眼及拔管时间明显缩短，疼痛评分明显升高（P<0.01）。
在神经外科手术中，瑞芬太尼或芬太尼联合丙泊酚TCI全静脉麻醉均可维持血流动力学稳定。瑞芬太尼联合丙泊酚靶控输注苏醒更快，但疼痛评分高于芬太尼。
