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題 名 | Combination of Bupivacaine Scalp Circuit Infiltration with General Anesthesia to Control the Hemodynamic Response in Craniotomy Patients=頭顱全範圍浸潤合併全身麻醉對開顱手術血行動力學的影響 |
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作 者 | 蕭介民; 陳宗鷹; 曾稼志; 張倍榮; 蔡玉娟; 張傳林; 李長光; | 書刊名 | 麻醉學雜誌 |
卷 期 | 36:4 1998.12[民87.12] |
頁 次 | 頁215-220 |
分類號 | 416.52 |
關鍵詞 | 局部麻醉劑; 開顱手術; 全身麻醉; Anesthetics, local; Bupivacaine; Craniotomy; Anesthesia, general; |
語 文 | 英文(English) |
中文摘要 | 背景:作開顱和術之病患,當下刀時其血壓及心跳往往會急速昇高,導致顱內壓繼續昇高,此情形對病人的生命及癒後有極大影響,尤其對患有腦血管瘤的病患更爲危險。本研究爲參攷Labat G在1921發表之方法及修正,使用局部麻醉劑作患側之頭部全範圍浸潤合併全身麻醉以觀察其對血行動力學的影響。方法:26位接受開顱手術病人,依日期分爲A組(16人)和B組(10人)。A組病患於手術前以0.25% bupivacaine25-30毫昇在患側頭部做全蕩圍浸潤,而B組則以同容量之生理食鹽水(0.9%)代替。下刀前每5分鍾記錄一次心跳,血壓。下刀後改爲每2分鍾記錄一次,直到下好後60分鍾。此外手術中並記錄呼出之isoflurane濃度(ET-Iso)。麻醉維持是以50%N2O(N2O:O2=2L:2L)與0.6%-1.2%之吐氣末isoflurane並將吐氣末之二氧化碳(end-tidal PCO2)保持在25-30mmHg。手術中若血壓及心跳之變化超過下刀前之20%,則給予thipental 2.5mg/kg及fentany 12μg/kg,兩分鍾後若血壓及心跳繼續偏高,則調整isoflurane之濃度來維持病人血行動力學的穩定。結果:A組與B組於手術中平均動脈壓之平均各爲92±1mmHg及92±7mmHg,但在下刀至6分鍾內具有統計學上的差異。手術中心跳平均分別爲A組91±2次/分,B組101±5次/分,過程中B組都較A組爲快但統計學上並無差異。兩組人之血壓及心跳變化超過下刀前之20%而需給藥在B組爲100%(10/10),A組則都不需額外給藥(0/16)。A組病人於下刀後60分鍾內其ET-Iso平均爲0.41±0.01%,B組則爲0.95±0.12%,ET-Iso在兩組有明顯的差異(P<0.05)。兩組病患於研究過程中並無不良之併發症。結論:使用患側頭顱全範圍浸潤合併全身麻醉對做開顱手術的病人之血壓,心跳都有相當的穩定效果。同時isoflurane的濃度亦相對減少,對病人於術中的安全性有相當的幫忙,值得推廣。 |
英文摘要 | Background: Sudden and overwhelming increases in blood pressure (BP) and heart rate (HR) during incision of the scalp may give rise to morbidity or mortality in patients with intracranial pathology undergoing neurosurgery. A modification of the method proposed by Labat to abate this circumstacranial was applied in a group of patients receiving craniotomy. The modified method was to combine scalp circuit infiltration of local anesthetic with general anesthesia to control the hemodynamic response to craniotomy. Methods: Twenty-six patients scheduled to undergo craniotomy were randomly divided into two groups. Patients whose conditions or their current medication that might affect the stability of hemodynamics were excluded. In group A patients (N=16) 25-30 ml of 0.25% bupivacaine was used for scalp circuit infiltration on the operation side, while in those of group B (N=10) the same volume of 0.9% normal saline was used. After induction, anesthesia was maintained with 0.6% to 1.2% end-tidal isoflurane (ET-Iso) and 50% N2O in oxygen (N2O:O2=21/min:2l/min). The end-tidal CO2 was kept within the range of 25-30 mmHg. BP and HR were recorded every five mm before incision and then every two mm after incision until one hour after induction. ET-Iso was also recorded every two mm throughout a period of sixty min. If the BP and HR increased above 20% of the baseline (10mm before incision), thiopental 2.5mg/kg and fentanyl 2pig/kg were administered. If hypertension became sustained, the isoflurane concentration was adjusted until an acceptable level was obtained. Results: The mean BP during the surgery was 92±1 mmHg in group A and 92±7 mmHg in group B. The difference in BP between incision to 6mm after incision was statistically significant (P<0.05). The mean HR during surgery was 101±5 beats/mm in group B and 91±2 beats/min in group A, the difference of which was not statistically significant. All of the patients in group B required a deepened anesthesia to keep the BP and HR within the normal range, but no patient in group A had such need. The average concentration of ET-Iso during the 60 mm period was 0.95 ± 0.12% in group B and 0.41±0.01% in group A, respectively. The difference was statistically significant (P<0.05). Conclusions: Our results showed that scalp circuit infiltration with 0.25% bupivacaine significantly improved the cardiovascular stability and reduced the requirement of isoflurane during craniotomy. The routine use of bupivacaine scalp circuit infiltration in patients undergoing craniotomy should be considered. |
本系統中英文摘要資訊取自各篇刊載內容。