摘要： 目的   对比观察瑞芬太尼静脉注射和罗哌卡因头皮局部麻醉抑制神经外科手术上头架期间血流动力学变化的作用。方法   选择40 例择期行开颅神经外科手术上头架患者，根据计算机随机数字表法分为瑞芬太尼静脉注射组（静脉麻醉组）和罗哌卡因头皮局部麻醉组（局部麻醉组），每组20 例患者。分别于上头架前静脉注射瑞芬太尼1 μg/kg 或1%罗哌卡因头钉处局部浸润麻醉，记录麻醉诱导前、给予局部麻醉药前、头架固定即刻，以及上头架后1、3、5 和10 min 的平均动脉压、心率。结果   两种麻醉方法虽均具有减慢心率的作用，但是以瑞芬太尼静脉注射对患者上头架后所有观察时间点心率的降低作用更为显著，且低于局部麻醉组（上头架后1 min：t = -2.027，P = 0.050；上头架后3 min：t = -3.244，P = 0.002；上头架后5 min：t = -6.850，P = 0.012；上头架后10 min：t = -2.774，P = 0.009）。无论采用何种麻醉方法，患者上头架后所有观察时间点平均动脉压均维持平稳，无明显波动，组间差异无统计学意义（P = 0.134）；而且，麻醉方法与测量时间之间无交互作用（P = 0.577）。但同一种麻醉方法的不同观察时间点之间，差异有统计学意义（P = 0.018），与给予局部麻醉药前比较，静脉麻醉组患者上头架后第5 和10 分钟时平均动脉压下降（t = 5.200，P = 0.007；t = 7.400，P = 0.000）；局部麻醉组患者上头架后第10 分钟时平均动脉压下降（t = 5.600，P = 0.002）。结论   神经外科手术上头架前静脉注射瑞芬太尼1 μg/kg和罗哌卡因头皮局部麻醉均可有效减轻上头架导致的血流动力学波动，静脉注射瑞芬太尼更便于操作。

关键词: 芬太尼, 麻醉, 静脉, 麻醉, 局部, 神经外科手术, 疼痛

Abstract: Objective To compare the effect of remifentanil bolus infusion or ropivacaine local infiltration on hemodynamic change during skull-pin insertion for craniotomy under general anesthesia. Methods Forty patients scheduled for craniotomy were randomly divided into 2 groups to receive remifentanil 1 μg/kg intravenously (group R) or local infiltration with 1% ropivacaine (group L) at pin site. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction or local infiltration just after skull-pin insertion, and 1, 3, 5 and 10 min after skull-pin insertion. Results The HR recorded at the time points after skull-pin insertion in group R was decreased significantly than that of group L (1 min after skull-pin insertion: t = -2.027, P = 0.050; 3 min after skull-pin insertion: t = -3.244, P = 0.002; 5 min after skull-pin insertion: t =-6.850, P = 0.012; 10 min after skull-pin insertion: t = -2.774, P = 0.009; respectively). The MAP recorded at the time points after skull-pin insertion did not differ significantly between the 2 groups (P = 0.134). The MAP recorded at 5 and 10 min after skull-pin insertion was significantly decreased than that before local infiltration (t = 5.200, P = 0.007; t = 7.400, P = 0.000; respectively) in group R. In group L, the MAP began to decrease significantly at 10 min after skull-pin insertion (t = 5.600, P = 0.002). Conclusion Both 1 μg/kg remifentanil intravenously and local infiltration with ropivacaine can prevent hemodynamic fluctuation during skull-pin insertion for craniotomy, while the former is easy to operate.

Key words: Fentanyl, Anesthesia, intravenous, Anesthesia, local, Neurosurgical procedures, Pain