不同麻醉方案对幕上脑肿瘤切除术患者颅内压、脑灌注压及麻醉复苏的影响

Effects of Different Anesthesia Programs on Intracranial Pressure,Cerebral Perfusion Pressure and Anesthesia Recovery in Patients with Supratentorial Brain Tumor Resection

目的探讨不同麻醉方案对幕上脑肿瘤切除术患者颅内压、脑灌注压及麻醉复苏的影响。方法选取行幕上脑肿瘤切除术的130例患者为研究对象,根据不同麻醉方案将入选的患者分为对照组及研究组,每组65例,对照组患者实施芬太尼、异丙酚、罗库溴铵联合咪达唑仑的麻醉方案,研究组患者实施舒芬太尼、异丙酚、罗库溴铵联合咪达唑仑的麻醉方案,比较两组患者麻醉诱导不同时间段颅内压(ICP)、脑灌注压(CCP)及麻醉苏醒期各指标变化。结果麻醉前两组患者ICP、CCP比较不存在显著差异性(P> 0.05),在插管后即刻至切皮后时间段两组患者ICP均明显升高,CCP均明显降低,开骨瓣、硬膜后两组ICP均明显降低,CCP均明显升高,但研究组显著优于对照组,两组比较存在显著差异性(P <0.05),研究组患者麻醉苏醒期拔管时间、苏醒时间、指令下握拳、活动下肢及定向力恢复均显著优于对照组,两组比较存在显著差异性(P <0.05)。结论舒芬太尼、异丙酚、罗库溴铵联合咪达唑仑的麻醉方案更有助于稳定患者麻醉后的颅内压及脑灌注压,避免术后苏醒延迟,在幕上脑肿瘤切除术麻醉中具有重要的应用价值。

Objective To explore effects of different anesthesia programs on intracranial pressure,cerebral perfusion pressure and anesthesia recovery in patients with supratentorial brain tumor resection. Methods 130 patients with supratentorial brain tumor resection were selected as the subjects from March 2015 to October 2017.According to the anesthesia program were divided into the control group and study group with 65 cases in each.The control group patients were treated with fentanyl,propofol,cisatracurium and midazolam anesthesia program,at the same time,the experimental group also received fentanyl and control group also received sufentanil.The changes of intracranial pressure(ICP),cerebral perfusion pressure(CCP)and anesthesia waking period during anesthesia induction at different time periods were compared between the two groups. Results There was no significant difference in ICP and CCP between the two groups before anesthesia( P >0.05).The ICP of both groups were significantly increased and CCP of both groups were significantly lower before induction ever since cannula until skin incision,ICP were significantly lower and CCP were significantly increased both the two groups after bone flap incision and putamen dissection,However,the study group was significantly better than the control group( P <0.05).The study group anesthesia recovery period of extubation time,wake time,fist under instruction,active lower extremity and directional recovery were significantly better than the control group( P <0.05). Conclusion Sufentanil,propofol,cisatracurium combined with midazolam anesthesia program more helpful to stabilize intracranial pressure,cerebral perfusion pressure after anesthesia in patients with supratentorial brain tumor resection and avoid delayed postoperative recovery,which has important application value.