瑞芬太尼麻醉对颅内肿瘤手术患者脑氧代谢及炎性细胞因子的影响

Effects of remifentanil on cerebral oxygen metabolism and inflammatory cytokines in patients undergoing surgery for intracranial tumors

目的探讨瑞芬太尼麻醉对颅内肿瘤手术患者的脑氧代谢、脑血流动力和炎性细胞因子的影响。方法选取2012年3月至2016年12月间山东省临朐县人民医院收治的50例拟行开颅肿瘤切除术的颅内肿瘤患者,根据麻醉用药的不同随机分为观察组与对照组,每组25例。观察组患者采用瑞芬太尼联合丙泊酚、罗库溴铵和七氟醚麻醉,对照组患者采用芬太尼联合丙泊酚、罗库溴铵和七氟醚麻醉。对比两组患者麻醉前和麻醉后20min脑血流动力学指标:阻力指数(RI)、收缩期血流速度(Vs)和舒张期血流速度(Vd),脑氧代谢指标:脑氧摄取率(CERO_2)、颈内静脉血氧含量(CjvO_2)和动脉-颈内静脉血氧含量差(Da-jvO_2)的变化,检测术前和术后18h超敏C反应蛋白(HsCRP)和肿瘤坏死因子-α(TNF-α)的表达水平。结果两组患者麻醉前,脑氧代谢指标、脑血流动力学指标及术前炎性细胞因子表达均无统计学意义。麻醉后20min,观察组患者Vs、Vd、CERO_2和CjvO_2均明显高于对照组,RI和Da-jvO_2显著低于对照组,差异均有统计学意义(均P<0.05)。术后18h,观察组患者Hs-CRP和TNF-α表达均明显低于对照组,差异均有统计学意义(均P<0.05)。结论瑞芬太尼在颅内肿瘤患者麻醉术中,不仅有利于脑氧代谢、脑血流的改善,还可降低炎性反应,安全性和临床效果更优。

Objective To investigate the effects of remifentanil on cerebral oxygen metabolism,cerebral hemodynamics and inflammatory cytokines in patients undergoing surgery for intracranial tumors.Methods Fifty patients with intracranial tumors about to undergo craniotomy resection at Linqu People＇s Hospital were selected from March 2012 to December 2016.Patients were randomly divided into an observation group and a control group according to the types of anesthesia drugs used with 25 patients in each group.The observation group received anesthesia using remifentanil plus propofol,rocuronium and sevoflurane.The control group received anesthesia using fentanyl plus rocuronium and sevoflurane.Changes in indexes of cerebral hemodynamics including resistance index（RI）,systolic blood flow velocity（Vs） and diastolic blood flow velocity（Vd）,and indexes of cerebral oxygen metabolism including cerebral oxygen uptake rate（CERO2）,Intrahepatic venous oxygen content（CjvO_2） and Arteries-poor blood oxygen content in the internal jugular vein（Da-jvO_2） were compared at 20 min before and after anesthesia.Expression of hypersensitive C-reactive protein（Hs-CRP） and tumor necrosis factor-a（TNF-a） was detected at 18 h before and after surgery.Results There were no significant differences in cerebral oxygen metabolism,cerebral hemodynamics and preoperative inflammatory cytokines before anesthesia.However,at 20 min after the anesthesia,levels of Vs,Vd CERO2 and CjvO_2 were significantly higher in the observation group than in the control group and levels of RI and Da-jvO_2 were lower in the observation group than in the control group（all P0.05）.At 18 h after the surgery,the expression of Hs-CRP and TNF-a were significantly lower in the observation group than in the control group（all P0.05）.Conclusion Remifentanil not only promotes cerebral oxygen metabolism and cerebral blood flow but also reduces the inflammatory reaction,which shows high safety and clinical efficacy in patients with intracranial tumors receiving anesthesia.