脑功能区手术唤醒麻醉方法的临床研究

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1、脑功能区手术唤醒麻醉方法的临床研究周声汉施冲刘中华广州军区广州总医院全军临床麻醉中心Clinicalstudyonanesthesialmethodsforawakecraniotomyofbrainfunctionalregion【Abstract】ObjectiveToexplorethemoresuitableanesthesialmethodsofawakecraniotomyforbrainfunctionalregion.,inordertoofferreferenceforselectinganesthesialmethodofawakecraniotom

2、y.MethodsSixtypatientsforawakecraniotomywererandomizedtoreceiveremifentanilandpropofoltarget-infusion(TRFgroup),manual-controlledinfusionwithpropofoltarget-infusion(MRFgroup)andintermittentfentanylwithpropofoltarget-infusion(IFgroup)accordingtodifferentanesthesialmethods,twentyrespective

3、ly.AnLMAisinsertedandventilationcontrolleduntilthetumourisexposedafterinducing,RemovaltheLMAeasytointerchargewithpatientwhenawaking,thepatientisre-anaesthetizedandtheLMAreplacedafterawaking.Judgingthefeasibilityandcontrollabilityofthreeanesthesialmethodsthroughobservingthevarityofhemodyn

4、amics,thequalityofawakingandincidenceofcomplicationduringawaken.ResultsAllpatientscompletedthesensor、motor、languagefunctiontesting.TheBPofIFgroupatawakingandbrainmappingmorethanbaseline(p＜0.05),TheBPofTRFandMRFgroupatawakingandbrainmappingwasnodifferencewithbaseline,TheBPandHRofTRFgroupw

5、aslessthanMRFandIFgroupatheadpinsinsertionandskinincision(p＜0.05);TheintraoperativeemergencetimeofTRF(16.6±6.4min)andMRF(16.6±6.4min)groupwaslessthanIFgroup(26.7±5.6min),p＜0.05;TheOAA/Sscoresat5and10minafterawakingbetweenTRFandMRFgreaterthanIF,buttherewerenodifferencesamongthethreegroups

6、inotherstimesaboutOAA/SandVASscores;Therewerenodifferencesabouttheincidenceintraoperativecomplicationsamongthethreegroups.ConlusionsTheuseofremifentanilandpropofoltarget-infusioninconjunctionwithLMAwassucceedingtoawakecraniotomyofbrainfunctionalregion;andpossessingmoreadvantagesincontrol

7、lingdepthofanesthesiaandthequalityofrevival.,deservingtorecommendforawakecraniotomyKeywordsremifentanil,fentanyl,propofol,target-infusion,brainfunctionalregion,awakecrainotomy，intra-operativewake-up脑功能区病变或肿瘤切除常引起神经功能障碍，对于运动语言区附近的肿瘤，唤醒麻醉是术中评价患者语言能力的唯一方法[1]。目前有多种麻醉技术应用于唤醒麻醉