不同麻醉用药对神经外科手术患者血流动力学及苏醒时间的影响

Influences of different anesthetic drugs on blood flow dynamics and wake-up in patients undergoing neurosurgical operation

目的观察不同麻醉用药对神经外科手术患者血流动力学及苏醒时间的影响。方法以我院2010—2012年收治的96例神经外科手术患者作为研究对象,根据手术麻醉所用的药物分为舒芬太尼组(A1组)、小剂量舒芬太尼组(A2组)和芬太尼组(B组),每组各32例。记录三组患者术前、术中的心率(HR)、平均动脉压(MAP)以及术后苏醒情况,并对结果进行比较。结果 (1)三组患者MAP在麻醉诱导后3、5 min时明显低于术前(P<0.05),B组患者HR、MAP在气管插管后、拔管和拔管后1 min明显高于术前,且与A1和A2组比较差异有统计学意义(P<0.05);A1组患者HR在诱导后5 min和插管后5 min明显低于术前水平(P<0.05),其MAP在插管后3、5 min明显低于术前水平(P<0.05);(2)A1和A2组在拔管后5、15 min其Steward评分均高于B组,其中A2组与B组比较差异有统计学意义(P<0.05),三组在拔管后30min比较无统计学差异(P>0.05)。结论舒芬太尼用于神经外科手术可使患者血流动力学相对平稳,术后苏醒较快,而小剂量舒芬太尼与之相比更具有优势。

Objective To observe the influence of different anesthetic drugs on blood flow dynamics and wake-up in patients undergoing neurosurgical operation. Methods A total of 96 patients undergoing neurosurgical operation admitted to our hospital from 2010 to 2012 were enrolled as subjects. According to different drugs and dosage used in the surgical operation, they were divided into Sufentanil anesthesia group （Group A1 ）, small dose Sufentanil group （Group A2） and Fentanyl group （Group B）. The case number per group was 32. Such parameters, as preoperative and perioperative heart rate （HR） , mean arterial pressure （MAP） and wake-up time were recorded and compared. Results （ 1 ） The MAPs of the three groups at 5 rain after induction were signifi- cantly lower than that before operation （P 〈 0.05 ）. The HR and MAP of Group B were significantly higher after endotracheal intubation, during extubation and 1 min after extubation than that before operation, which was obviously different from that of Group A1 and A2 （ P 〈 0. 05 ）. The HR of Group A1 was significantly lower at 5 min after induction than before operation （ P 〈 0. 05 ） , and its MAPs at 3-and 5 rain after intubation were also significantly lower than that before （ P 〈 0.05 ）. （2） The Steward scores of Group A1 and A2 at 5- and 15 min after extubation were higher than that of Group B, and the differences between Group A2 and Group B were obviously different （ P 〈 0. 05 ）. The scores of the three groups at 30 min after extubation were of no obvious difference （ P 〉 0.05 ）. Conclusion Sufentanil used in neurosurgical operation makes the hemodynamics of patients relatively stable and their postoperative wake-up faster. It is suggested that small dose of Sufentanil is used.