3.0T高场强术中磁共振检查期间1.3MAC七氟烷对患者麻醉质量的影响
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摘要
目的探讨高场强下神经外科术中磁共振检查期间1.3MAC(最低肺泡有效浓度)七氟烷和静吸复合两种麻醉维持方式的不同麻醉效果和患者苏醒质量。方法 40例在静吸复合麻醉下择期行脑部肿瘤切除术的患者,术中MR检查时随机分为1.3MAC七氟烷吸入组(S组)和保持原静吸复合麻醉组(C组),记录并比较两组术前(T_0)、术中MR扫描前(T_1)、术中MR扫描结束时(T_2)、手术结束(T_3)各时点的收缩压(SP)、舒张压(DP)、心率(HR)。对两组手术时间、术中出血量、MR扫描的次数和时间及MR成像满意度、麻醉苏醒和拔管时间、术后躁动、恶心呕吐、有无术中知晓进行比较。结果两组血压和心率T_0、T_1、T_3组间比较差异无统计学差异。T_2时S组收缩压(SP)低于C组(P<0.05)。两组术中接受MR扫描次数时间、手术时间及出血量、MR成像满意度、苏醒及拔管时间差异无统计学差异。两组均未发生术中知晓。结论 3.0T高场强术中MR期间1.3MAC七氟烷维持麻醉具有同样的安全性,对患者无不良影响。
Objective To investigate the different anesthetic effects and the quality of recovery of patients with 1.3 MAC(lowest alveolar effective concentration)sevoflurane and intravenous inhalation during high magnetic field examination.Methods Forty patients who underwent elective brain tumor resection under inhalation combined with anesthesia were randomly assigned to a 1.3 MAC sevoflurane inhalation group(S group)and a primary intravenous inhalation anesthesia group(C group).Systolic blood pressure(SP)and diastolic blood pressure(DP)and Heart rate(HR)were recorded and compared between the two groups,before operation(T_0),preoperative MR scan(T_1),intraoperative MR scan(T_2),and end of surgery(T_3).The operation time,intraoperative blood loss,MR scan frequency and time,MR imaging satisfaction,anesthesia recovery and extubation time,postoperative agitation,nausea and vomiting,and intraoperative awareness were compared.Results There was no significant difference in blood pressure and heart rate between the two groups(T_0,T_1,T_3).The systolic blood pressure(SP)of the S group was lower than that of the C group at T_2(P<0.05).There were no significant differences in the number of MR scans,the duration of surgery and the amount of bleeding,MR imaging satisfaction,wakefulness,and extubation time between the two groups.No intraoperative awareness occurred in either group.Conclusion In the 3.0 Thigh field strength procedure,1.3 MAC sevoflurane maintained the same safety during MR and had no adverse effects on the patient.
Objective To investigate the different anesthetic effects and the quality of recovery of patients with 1.3 MAC(lowest alveolar effective concentration)sevoflurane and intravenous inhalation during high magnetic field examination.Methods Forty patients who underwent elective brain tumor resection under inhalation combined with anesthesia were randomly assigned to a 1.3 MAC sevoflurane inhalation group(S group)and a primary intravenous inhalation anesthesia group(C group).Systolic blood pressure(SP)and diastolic blood pressure(DP)and Heart rate(HR)were recorded and compared between the two groups,before operation(T_0),preoperative MR scan(T_1),intraoperative MR scan(T_2),and end of surgery(T_3).The operation time,intraoperative blood loss,MR scan frequency and time,MR imaging satisfaction,anesthesia recovery and extubation time,postoperative agitation,nausea and vomiting,and intraoperative awareness were compared.Results There was no significant difference in blood pressure and heart rate between the two groups(T_0,T_1,T_3).The systolic blood pressure(SP)of the S group was lower than that of the C group at T_2(P<0.05).There were no significant differences in the number of MR scans,the duration of surgery and the amount of bleeding,MR imaging satisfaction,wakefulness,and extubation time between the two groups.No intraoperative awareness occurred in either group.Conclusion In the 3.0 Thigh field strength procedure,1.3 MAC sevoflurane maintained the same safety during MR and had no adverse effects on the patient.
引文
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[10]Kuhnt D,Ganslandt O,Schlafer SM,et al.Quantification of glioma removal by intraoperative high-field magnetic resonance imaging:an update[J].Neurosurgery,2011,69(4):852~862.
[2]Sylvester P T,Evans J A,Zipfel G J,et al.Combined high field intraoperative magnetic resonance imaing and endoscopy increase extent of resection and progression free survival for pituitary adenomas[J].Pituitary,2015,18(1):72~85.
[3]谭明.全凭静脉和静吸复合麻醉在超高场强核磁共振神经外科手术中的麻醉效果比较[J].中国实用神经疾病杂志,2015,(20):40~41.
[4]时文珠,公茂伟,孙立,等.神经外科术中MRI时麻醉深度的调控[J].中国临床神经外科杂志,2010,15(4):204~206.
[5]Avidan M S,Zhang L,Burnside B A,et al.Anesthesia awareness and the bispectral index[J].N Engl J Med,2008,358:1097~1108.
[6]方才.吸入麻醉药对中枢神经系统功能的影响[J].立体定向和功能性神经外科杂志,2008,21(1):48~51,58.
[7]时文珠,孙立,公茂伟,等.术中高场强磁共振扫描对心电图的影响[J].北京医学,2009,31(10):581~583.
[8]丁晓楠,张军,梁伟民.围麻期超高场强术中磁共振对全身麻醉患者体温的影响[J].复旦学报(医学版),2013,40(5):594~597.
[9]张军,丁晓楠,汪乐天,等.术中磁共振影像神经导航手术的麻醉管理[J].临床麻醉学杂志,2008,24(2):112~113.
[10]Kuhnt D,Ganslandt O,Schlafer SM,et al.Quantification of glioma removal by intraoperative high-field magnetic resonance imaging:an update[J].Neurosurgery,2011,69(4):852~862.