瑞芬太尼与舒芬太尼对重症颅脑损伤患者术后早期认知功能的影响比较

Comparison of the Effects of Remifentanil and Sufentanil on Early Cognitive Function in Patients with Severe Craniocerebral Injury

目的:对比分析重症颅脑损伤(SCI)围麻醉期分别应用瑞芬太尼和舒芬太尼辅助麻醉对患者术后早期认知功能的影响。方法:选择2017年5月-2018年5月于笔者所在医院行开颅术治疗的126例SCI患者,依据随机数字表法均分成两组。瑞芬太尼组(RF组,63例)于麻醉诱导前10 min静脉泵注瑞芬太尼0.1μg/kg,而后以12.0μg/(kg·h)维持。舒芬太尼组(SF组,63例)于同时点静脉泵注舒芬太尼0.2μg/kg,而后以0.15μg/(kg·h)维持。比较两组各时点[麻醉诱导前(T0)、插管后5 min(T1)、切开脑硬膜时(T2)、苏醒时(T3)]生命体征及脑血流动力学指标变化,苏醒时间,以及术后15 min时简易精神状态量表(MMSE)、瑞秋洛斯阿米哥斯量表(RLAS)评分。结果:两组围术期平均动脉压(MAP)、心率(HR)对比差异均无统计学意义(P>0.05)。与SF组相比,RF组T1、T2、T3时脑血流动力学参数[平均血流量(Qmean)、平均血流速度(Vmean)]值明显更低(P<0.05)。RF组苏醒时间显著早于SF组(P<0.01),而术后15 min时MMSE、RLAS评分均显著高于SF组(P<0.01)。结论:在SCI围麻醉期采取舒芬太尼辅助麻醉较瑞芬太尼更有助于维持患者生命体征及脑血流动力学状态稳定,但瑞芬太尼在改善SCI患者术后早期认知功能方面优势突出。

Objective:To compare analyze of the effects of Remifentanil and Sufentanil anesthesia on early cognitive function in patients with severe craniocerebral injury(SCI)during anesthesia.Method:From May 2017 to May 2018,126 cases with SCI who underwent craniotomy in our hospital were selected,and divided them into two groups randomly.Remifentanil group(RF group,63 cases)was intravenously injected with Remifentanil 0.1μg/kg 10 min before anesthesia induction,and then maintained at 12.0μg/(kg·h).Sufentanil group(SF group,63 cases)was intravenous pumped with Sufentanil 0.2μg/kg at the same time and then maintained at 0.15μg/(kg·h).Two groups’vital signs and changes in cerebral hemodynamics at each time[before anesthesia induction(T0),5 minutes after intubation(T1),incision of the brain dura(T2),and recovery(T3)],scores of Simple Mental State Scale(MMSE)and Rancho Los Amigos Scale(RLAS)in wakeup time and 15 minutes after surgery were compared.Result:Here was no statistical significance in mean arterial pressure(MAP)and heart rate(HR)during perioperative period between two groups(P >0.05).Compared with those in SF groups,RF group’s cerebral hemodynamic parameters[mean blood flow(Qmean),mean blood flow velocity(Vmean)]at T1,T2,T3 were significant lower(P<0.05).RF group’s wakeup time was significant shorter than that in SF group(P<0.01),and MMSE,RLAS scores at 15 minutes after surgery were significant higher than those in SF group(P<0.01).Conclusion:Sufentanil-assisted anesthesia during SCI perianesthesia is more helpful than remifentanil to maintain vital signs and cerebral hemodynamics,but Remifentanil has outstanding advantages in help patients with SCI to improve early cognitive function.