瑞芬太尼联合丙泊酚应用于颅脑手术麻醉的临床效果

Clinical Effect of Remifentanil Joint Propofol in Craniocerebral Surgery Anesthesia

目的评价瑞芬太尼联合丙泊酚应用于颅脑手术麻醉的临床效果。方法选择2015年3月至2016年2月常州市第一人民医院就诊且需行颅脑手术的患者120例,采用随机数字法分为对照组和观察组,各60例,分别采用芬太尼复合丙泊酚及瑞芬太尼联合丙泊酚进行麻醉,对照组术中维持芬太尼靶浓度为3μg/(kg·min)、丙泊酚靶浓度为3μg/(kg·min);观察组术中维持瑞芬太尼靶浓度为0.25μg/(kg·min)、丙泊酚靶浓度为3μg/(kg·min)。对比两组患者不同时刻的血流动力学参数水平、麻醉维持时间、睁眼时间、拔管时间以及麻醉前后脑代谢相关指标。结果两组的平均动脉压(MAP)和心率水平在气管插管前(T_1)时出现显著下降,而在气管插管后即刻(T_2)时显著升高,随后在T_2、手术开始后30 min(T_3)及拔管即刻(T_4)时趋于平缓,差异有统计学意义(P<0.05);且观察组在T_2、T_3、T_4时的MAP和心率水平均低于对照组,两组的MAP和心率水平在组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。两组麻醉维持时间比较差异无统计学意义(P>0.05),观察组睁眼时间、拔管时间较对照组显著缩短;两组CMRO_2水平在麻醉维持后10 min后均发生下降,对照组在停药后5 min上升,组内比较差异有统计学意义(P<0.05);两组CjvO_2水平和Da-jvO_2水平在各时间段的波动幅度不大,差异无统计学意义(P>0.05)。结论颅脑手术患者实施瑞芬太尼复合丙泊酚麻醉,可有效维持血流动力学的稳定,缩短苏醒时间及拔管时间,同时可促进脑氧代谢稳定,值得在临床广泛应用。

Objective To evaluate the clinical effect of remifentanil combined with propofol in craniocerebral anesthe- sia. Methods A total of 120 patients needing brain surgery were selected in Changzhou First People＇s Hospital from Mar. 2015 to Jan. 2016 were included in the study,and were divided into a control group and an observation group according to the random number method ,60 cases in each group ,fentanyl combined with propofol and remifentanil combined with propo- fol were adopted for anesthesia respectively, and the control group was maintained with fentanyl at the target concentration of 3 μg/（ kg · min）, propofol at the target concentration of 3 μg/（ kg · min） ;in the observation group, the target concentration of remifentarfil was 0. 25 μg/（ kg · min） ,and the target concentration of propofol was 3 μg/（ kg · min）. The hemodynamie parameters level, anesthesia duration, eye opening time, extubation time and brain metabolism indexes before and after anes- thesia of the two groups at different time points were compared. Results The mean arterial pressure（MAP） and heart rate in both groups decreased significantly before intubation（ T1 ） and increased immediately after intubation（ T2 ）, then became stable after Tz ,at 30 min after the start of surgery（ T3 ） and immediately after extubation（ T4 ） ,the difference was statistically significant （ P 〈 0. 05 ） ; MAP and heart rate in the observation group were lower than those in the control group at Tz, T3 and T4. There was significant difference in the MAP and heart rate between the two groups,between the time points and between group ~ time point interaction （ P 〈 O. 05 ）. The anesthesia duration of two groups had no statistically significant difference（P 〉 0. 05 ） ,eye opening time and extubation time of the observation group were significantly shorter than those of the control group;the level of CMRO2 in the two groups was decreased after 10 rain,and the control group＇s was increased 5 rain after withdrawal, the difference was statistically significant wthin the group（P 〈 0. 05 ） ;the fluctuations of CjvO2 levels and Da-jvO2 levels of two groups in each period of the time range were not big, the difference was not statistically significant （P 〉 0. 05）. Conclusion Remifentanil combined with propofol anesthesia can effectively maintain the stability of hemody- namics,shorten the time of awakening and extubation, and promote the stability of cerebral oxygen metabolism, thus is worthy to be widely applied in clinical.