唤醒麻醉开颅术中普鲁泊福复合瑞芬太尼或舒芬太尼对认知功能的影响

Effects of propofol combined with remifentanil or sufentanil on cognitive function in patients undergoing awake craniotomy

目的探讨开颅术唤醒麻醉中应用普鲁泊福复合瑞芬太尼或舒芬太尼对认知功能的影响。方法择期行大脑皮质功能区肿瘤切除术患者60例，ASA分级I～Ⅱ级。按随机数字表法分为瑞芬太尼＋普鲁泊福组（RF组）和舒芬太尼＋普鲁泊福组（sF组），每组30例。在头皮神经阻滞、切口浸润麻醉和硬脑膜表面麻醉下，静脉靶控输注瑞芬太尼血浆浓度为1～2ng／ml，舒芬太尼血浆浓度为0．1-0．2ng,／ml镇痛；开颅期普鲁泊福血浆浓度为3～6μg／ml。放置喉罩控制呼吸。常规监测循环、呼吸等各项指标，脑电双频指数（BIS）监测麻醉深度。在术前、术中（被唤醒后）应用简易智能检查量表（MMSE）进行评分。结果清醒时普鲁泊福血浆浓度RF组为（1．10±0．06）μg／ml，SF组为（0．98±0．05）μg／ml，自主呼吸恢复。RF组BIS从停药时46．4±2．5恢复到90．8±3．2、SF组从44．8±2．1恢复到89．9±3．2，患者清醒。两组术前、术中认知功能评分组间、组内比较差异均无统计学意义（P〉0．05）。结论开颅术唤醒麻醉中应用普鲁泊福复合瑞芬太尼或舒芬太尼靶控静脉麻醉对认知功能无影响。

Objective To investigate the effect of propofol combined with remifentanil or sufentanil on cognitive function in patients undergoing awake craniotomy. Methods Sixty ASA I or Ⅱ neurosurgical patients undergoing resection of glioma in cerebral cortical functional area were divided into 2 groups by random digits table： propofol ＋ remifentanil （group RF, 30 cases） and propofol ＋ sufentanil （group SF, 30 cases ）. Scalp nerve block and local infiltration of incision and dura mater were performed in both groups with 0.5% ropivaeaine. Propofol, remifentanil and sufentanil were administered by target controlled infusion. The target plasma concentration of remifentanil was set at 1-2 ng/ml and that of snfentanil at 0.1-0.2 ng/ml, propofol was set at 3-6 μg/ml at open skull stage. The patients were inserted laryngeal mask and mechanically ventilated. Bispectral index （ BIS ） was monitored as the depth of anesthesia. Mini-mental scale examination （ MMSE ） was investigated at the time of preoperative, intraoperative wake-up after the patients had been targeted capacity. Results Blood concentration of propofol in group RF was （1.10± 0.06） μ g/ml, group SF was （0.98 ± 0.05）μ g/ml in patients during intraoperative wake-up. BIS in group RF changed from 46.4 ±2.5 to 90.8 ±3.2 during wake-up, group SF from 44.8±2.1 to 89.9 ±3.2. The cognitive function score was not significantly different at the time of preoperative and intraoperative assessment. Conclusion Propofol combined with remifentanil or sufentanil has no effect on cognitive function for the patients undergoing awake craniotomy.