脑功能区手术唤醒麻醉方法及临床研究.docVIP

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 Clinical study on anesthesial methods for awake craniotomy of brain functional region 【Abstract】 Objective To explore the more suitable anesthesial methods of awake craniotomy for brain functional region., in order to offer reference for selecting anesthesial method of awake craniotomy. Methods Sixty patients for awake craniotomy were randomized to receive remifentanil and propofol target-infusion(TRFgroup), manual-controlled infusion with propofol target-infusion(MRFgroup) and intermittent fentanyl with propofol target-infusion(IFgroup) according to different anesthesial methods, twenty respectively. An LMA is inserted and ventilation controlled until the tumour is exposed after inducing, Removal the LMA easy to intercharge with patient when awaking, the patient is re-anaesthetized and the LMA replaced after awaking. Judging the feasibility and controllability of three anesthesial methods through observing the varity of hemodynamics, the quality of awaking and incidence of complication during awaken. Results All patients completed the sensor、motor、language function testing. The BP of IF group at awaking and brain mapping more than baseline(p＜0.05),The BP of TRF and MRF group at awaking and brain mapping was no difference with baseline, The BP and HR of TRF group was less than MRF and IF group at headpins insertion and skin incision(p＜0.05); The intraoperative emergence time of TRF(16.6±6.4min) and MRF(16.6±6.4min) group was less than IF group(26.7±5.6min), p＜0.05; The OAA/S scores at 5 and 10min after awaking between TRF and MRF greater than IF, but there were no differences among the three groups in others times about OAA/S and VAS scores; There were no differences about the incidence intraoperative complications among the three groups. Conlusions The use of remifentanil and propofol target-infusion in conjunction with LMA was succeeding to awake craniotomy of brain functional region; and possessing more advantages