颅脑疾病病人手术中舒芬太尼麻醉效果观察

Effect of sufentanil anesthesia on craniocerebral injury patients treated with operation

目的:探讨颅脑疾病病人手术中舒芬太尼的麻醉效果。方法:选取择期进行开颅手术的78例病人作为研究对象,随机分为观察组和对照组,各39例。对照组病人采用瑞芬太尼进行麻醉,观察组采用舒芬太尼进行麻醉,比较2组病人麻醉诱导前(T_0)、气管插管时(T_1)、插管后3 min(T_2)、插管后5 min(T_3)、以及拔管时(T_4)各时间段心率(HR)、血压的变化以及血肾上腺素(AD)、去甲肾上腺素(NE)、皮质醇(CORT)的含量,并对手术后的自主呼吸恢复时间、睁眼时间、意识清醒时间、拔管时间以及拔管反应等进行观察。结果:血流动力学方面:组内比较,2组T_1、T_2、T_3以及T4时的收缩压(SBP)、舒张压(DBP)、HR以及血氧饱和度(SpO_2)水平均较T_0时明显下降(P<0.01);组间比较,观察组T_1、T_2、T_3以及T4时的SBP和HR水平均明显高于对照组(P<0.01);观察组T_2、和T4时DBP水平高于对照组(P<0.01),T_1时低于对照组(P<0.01),T_3时与对照组差异无统计学意义(P>0.05);观察组T_2和T4时SpO_2水平高于对照组(P<0.01),T_3时与对照组差异无统计学意义(P>0.05)。血液指标检测方面:组内比较,对照组T_1、T_2、T_3时的AD、NE以及CORT水平相比T_0时均明显升高(P<0.01),而观察组各时间点AD、NE以及CORT水平差异均无统计学意义(P>0.05);组间比较,观察组T_1、T_2以及T_3时的AD、NE以及CORT水平均明显低于对照组(P<0.01)。术后观察:观察组病人自主呼吸恢复时间、睁眼时间、意识清醒时间以及拔管时间均较对照组明显延长(P<0.01),拔管反应率低于对照组(P<0.05)。结论:应用舒芬太尼麻醉在减少对颅脑手术病人心血管的刺激,降低术中及术后拔管的应激反应优于瑞芬太尼。

Objective：To study the effects of sufentanil anesthesia on craniocerebral injury patients treated with operation. Methods：Seventy-eight patients scheduled by craniotomy were randomly divided into the observation group and control group （ 39 cases each group）. The control group and observation group were anaesthetized by remifentanil and sufentanil,respectively. The heart rate（HR）, blood pressure,and levels of blood epinephrine（AD）,noradrenaline（NE） and cortisol（CORT） between two groups were compared before induction anesthesia （ T0 ） , during nasotracheal intubation （ T1 ） , after 3 and 5 min of extubation （ T2 and T3 ） , and during extubation（ T4 ） . The breathing recovery time,opening eye time,conscious time,extubation time and extubation reaction after operation in two groups were recorded. Results：Hemodynamics：compared with T0 , the levels of systolic pressure （ SBP ） , diastolic pressure （DBP）,HR and oxygen saturation（SpO2） in two groups significantly decreased at T1,T2,T3 and T4（P〈0. 01）. The levels of SBP and HR in observation group at T1,T2,T3 and T4 were significantly higher than those in control group（P〈0. 01）,the levels of DBP in observation group at T1,and T2 and T4 were lower and higher than that in control group,respectively（P〈0. 01）,and the difference of the level of DBP at T3 between two groups was not statistically significant（P〉0. 05）. The levels of SpO2 in observation group at T2 and T4 were higher than that in control group（P 〈0. 01）,and the difference of the level of SpO2 at T3 between two groups was not statistically significant（P 〉0. 05）. Blood index detection：compared with T0,the levels of AD,NE and CORT in control group significantly increased at T1,T2 and T3（P〈0. 01）,and the differences of the levels of AD,NE and CORT in observation group between all time-points were not statistically significant（P〉0. 05）. The levels of AD,NE and CORT in observation group at T1,T2 and T3 were significantly lower than those in control group（P〈0. 01）. Postoperative observation：the spontaneous breathing recovery time,opening eye time,conscious time and extubation time in observation group were significantly longer than those in control group（P〈0. 01）,and the extubation reaction rate in observation group was lower than that in control group（P 〈0. 05）. Conclusions：Compared with remifentanil,the sufentanil anesthesia can reduce cardiovascular stimulation,and the intraoperative and postoperative extubation stress reaction in craniocerebral injury patients treated with operation.