舒芬太尼复合丙泊酚对急性高血压脑出血手术患者血流动力学的影响

Effect of sufentanil combined with propofol on hemodynamics in patients undergoing acute hypertensive erebral hemorrhage surgery

①目的比较舒芬太尼、瑞芬太尼联合芬太尼及芬太尼三者复合丙泊酚麻醉对急性高血压脑出血手术患者血流动力学的影响。②方法选择高血压脑出血患者90例,ASAⅡ～Ⅲ级,年龄38～68岁,体质量63～95kg。随机分为芬太尼组(F组,对照组),瑞芬太尼联合芬太尼组(RF组)和舒芬太尼组(S组),每组30例。麻醉诱导芬太尼3～4μg/kg(F组和RF组)/舒芬太尼0.8μg/kg(S组)静脉注射,术中F组以芬太尼2μg/(kg.h),RF组以瑞芬太尼0.15～0.2μg/(kg.min),S组以舒芬太尼0.35μg/(kg.h)维持麻醉。分别记录各组患者麻醉诱导前(T0)、诱导后3min(T1)、气管插管即刻(T2)、插管后5min(T3)、切皮(T4)、开骨瓣(T5)、缝硬脑膜时(T6)、术毕即刻(T7)、术毕30min(T8)的SBP、DBP、HR与副作用。③结果在T1时,3组患者SBP、DBP均较T0时降低(P<0.05),组间比较无统计学意义(P>0.05)。在T2、T7～8时,S组SBP、DBP明显低于F组和RF组(P<0.05)。在T3～6时,S组SBP、DBP明显低于F组(P<0.05)。在T1～8时,S组HR明显低于F组和RF组(P<0.05)。与F组、RF组比较,S组高血压、心动过速、术后呛咳的发生率均明显减少(P<0.05);与RF组比较,S组、F组呼吸抑制的发生率明显增多(P<0.05)。④结论舒芬太尼复合丙泊酚麻醉用于高血压脑出血颅内血肿清除术患者麻醉手术期间血液动力学平稳,不良反应少,是一种安全有效的麻醉方法。

Objective To compare effect of propofol combined with sufentanil or remifentanil combined with fentanyl or fen- tanyl on hemodynamics in patients undergoing acute hypertensive erebral hemorrhage surgery. Methods 90patients with hyperten- sive erebral hemorrhage （ ASA Ⅱ～Ⅲ, age 38 to 68 ,weighing 63 to 95 ） were randomly divided into 3 groups ：fentanyl group（ group F, control group, n = 30 ）, remifentanil compound fentanyl group （ group RF, n = 30）, sufentanil group （ group S, n = 30 ）. Anesthesia was induced with iv injection of fentanyl 3 - 4 μg/kg （group F and group RF） or sufentanil 0.81xg/kg （group S ）. Anesthesia was maintained with fentanyl 2μg/（ kg h） （ group F） ,remifentanil O. 15 - 0.2μg/kg min（ group RF）, sufentanil 0.35 μg/（ kg h ） （ group S）. SBP, DBP and HR of 3 groups were observed at pre - induction （ TO ） ,3 min after induction （ T1 ）, immediately after en- dotracheal tube （T2） ,5min after endotracheal tube （T3）, the time of incision in skin （T4）, the time of opening bone flap（ T5 ）, the time of seaming dura （T6） , immediately after completing the surgery （T7）, 30min after completing the surgery （T8） ;the intraopera- tire cardiovascular adverse events,and postoperative respiratory depression and cough reaction were also recorded. Results Com- pared with TO ,the SBP and DBP of patients in 3 groups were reduced at T1 （ P 〈 0.05 ）, there were no significant deference be- tween three groups （ P 〉 0.05）. at T2,T7 -8,in group S, SBP and DBP were significantly lower than those in group F and group RF（ P 〈0.05）. at T3 -6,in group S,SBP and DBP were aslo lower than those in group F（ P 〈0.05）. at T1 -8,HR in group S was significantly lower than that in group F and group RF（ P 〈0.05）. compared with group F and group RF,in group S,the inci- dence of hypertension,tachycardia,postoperative cough were significantly lower（ P 〈0.05 ）. compared with group RF,in group S and group F, the incidence of respiratory depression increased significantly （ P 〈 0.05 ）. Conclusion Hemodynamics was more sta- ble in patients undergoing intracerebral hematoma in hypertensive erebral hemorrhage, sufentanil combined with propofol was a safe, effective method of anesthesia.