舒芬太尼与芬太尼在神经外科手术麻醉中的应用比较

Comparative study of sufentanil and fentanyl on patients undergoing neurosurgical surgery

目的:比较舒芬太尼和芬太尼用于神经外科手术麻醉时的血流动力学变化。方法:选择56例神经外科肿瘤手术病人,随机分舒芬太尼组(S组,n=28)和芬太尼组(F组,n=28)。麻醉诱导采用丙泊2.0 mg/kg,琥珀胆碱1.5 mg/kg,S组用舒芬太尼0.4μg/kg,F组用芬太尼3μg/kg,气管插管后机械通气,给予维库溴铵0.1 mg/kg,术中S组静脉持续泵入舒芬太尼0.2μg/(kg.h),F组芬太尼2μg/(kg.h)静注,两组均静脉持续泵注丙泊酚4～12 mg/(kg.h)调整麻醉深度,间断追加维库溴铵。记录围麻醉期血流动力学变化。结果:F组HR在插管后1 min、开颅、关颅、呼吸恢复后即刻及拔管后与基础值比较有显著性差异(P<0.05);S组HR插管后与基础值比较无显著差异(P>0.05),开颅、呼吸恢复后即刻及拔管后与基础值比较有显著性差异(P<0.05)。F组切皮时、拔管后MAP较基础值增高(P<0.05),S组在所有时间点无显著差异(P>0.05)。结论:舒芬太尼复合丙泊酚应用于神经外科手术患者全麻过程中血流动力学更稳定,更适用于神经外科手术麻醉。

Objective：To compare the effects of sufentanil and fentanyl on hemody namics reaction in patients undergoing neurosurgical surgery. Methods：A total o f fifty-six ASA physical status I or II patients scheduled for intracranial tum orresection were randomized to S（sufentanil）or F（fentanyl）group（28 for each）.In duction of anesthesia was begun with propofo 2.0 mg/kg,succinylcholine 1.5 mg /kg, group S sufentanil 0.4 μg/kg,group F fentanyl 3 μg/kg.Mechanical ventilatio n w as performed after tracheal intubation,followed by continuous intravenous pumpin g of propofol（4-12 mg/（kg·h）） and sufentanil（0.2 μg/（kg·h））（group S） or fe ntanyl （2 μg/kg）（group F1.Vecuronium 2 mg was injected at intervals of 45-60 min.The pa t ient＇s blood pressure,heart rate were continuously monitored and recorded. Results：In group F,the Heart Rates（HR）during l min after endotracheal intubation,dural incision and closure,spontaneous breath recovery and after tracheal ext ubation were higher than baseline value（P0.05）,while they were higher th an bas eline value during dural incision,spontaneous breath recovery and after trachea l extubation in groupS （P0.05）.Group F on MAP at skin incision and after trache al extubation were higher than baseline value（P0.05）,but group S was not differ ent from baseline value（P0.05）. Conclusion：Sufentanil combining with pr opofol and sevoflurane is more stable applying in the anesthesia induction and mainten ance and sup erior to fentanyl in general anesthesia in intracranial surgery.