瑞芬太尼对颅脑手术患者脑血流的影响研究

Study of effect of remifentanil on cerebral blood flow in patients undergoing craniocerebral operation

目的研究瑞芬太尼对颅脑手术患者脑血流的影响。方法 100例颅脑手术患者作为研究对象,根据双盲法分为实验组和对照组,各45例。对照组患者采用芬太尼进行麻醉,实验组患者采用瑞芬太尼进行麻醉。对比两组患者麻醉前、麻醉后10 min、麻醉后30 min、停药后5 min的大脑动脉血流动力学指标[收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)]、脑血管血液动力学指标[平均血流量(Qmean)、脉搏波波速(Wv)、动态阻力(DR)、临界压力(CP)]、脑血氧指标[脑氧摄取率(CERO2)、颈内静脉血氧含量(CjvO2)、动脉-颈内静脉血氧含量差(Da-jvO2)]水平。结果麻醉前、麻醉后10 min、30 min以及停药后5 min,实验组患者的RI水平分别为(0.67±0.10)、(0.70±0.12)、(0.72±0.17)、(0.69±0.09),Vs水平分别为(68.26±6.41)cm/s、(66.26±5.92)cm/s、(66.93±6.13)cm/s、(67.73±6.26)cm/s,Vd水平分别为(25.56±2.03)cm/s、(23.79±1.92)cm/s、(23.88±1.90)cm/s、(24.72±1.98)cm/s;麻醉前、麻醉后10 min、30 min以及停药后5 min,对照组患者的RI水平分别为(0.68±0.11)、(0.86±0.15)、(0.88±0.17)、(0.85±0.15),Vs水平分别为(68.45±6.43)cm/s、(62.51±5.28)cm/s、(62.65±5.73)cm/s、(63.27±6.04)cm/s,Vd水平分别为(25.54±2.04)cm/s、(21.01±1.43)cm/s、(21.57±1.62)cm/s、(22.28±1.70)cm/s;麻醉前,两组患者的R1、Vs、Vd水平比较差异均无统计学意义(P>0.05);麻醉后10 min、30 min以及停药后5 min,实验组患者的RI水平均低于对照组,Vs以及Vd水平均高于对照组,差异均具有统计学意义(P<0.05)。麻醉前,两组患者的Qmean、Wv、CP、DR水平比较,差异均无统计学意义(P>0.05);麻醉后10 min、30 min以及停药后5 min,实验组患者的Qmean水平均高于对照组,Wv、CP以及DR水平均低于对照组,差异均具有统计学意义(P<0.05)。麻醉前,两组患者的CERO2、CjvO2、Da-jvO2水平比较,差异均无统计学意义(P>0.05);麻醉后10 min、30 min以及停药后5 min,实验组患者的CERO2以及CjvO2水平均高于对照组,Da-jvO2水平均低于对照组,差异均具有统计学意义(P<0.05)。结论颅脑手术患者采用瑞芬太尼进行麻醉,患者的大脑动脉血流动力学、脑血管血液动力学以及脑血氧能够受到的影响更小,其安全性也就更高。

Objective To study the effect of remifentanil on cerebral blood flow in patients undergoing craniocerebral operation.Methods A total of 100 patients undergoing craniocerebral operation as study subjects were divided into experimental group and control group by double-blind methd,with 45 cases in each group.The control group received for fentanyl anesthesia,and the experimental group received remifentanil for anesthesia.The levels of hemodynamic indexes of cerebral artery [systolic peak flow velocity(Vs),end-diastolic flow velocity(Vd),resistance indexes(RI)],cerebrovascular hemodynamic indexes [mean blood flow(Qmean),pulse wave velocity(Wv),dynamic resistance(DR),critical pressure(CP)],and cerebral blood oxygen indexes [cerebral ex-traction rate of oxygen(CERO2),jugular venous oxygen saturation(CjvO2),content of artery-internal differences in oxygen(Da-jvO2)] before anesthesia,10 min after anesthesia,30 min after anesthesia,5 min after drug withdrawal was compared between the two groups.Results Before anesthesia,10 min after anesthesia,30 min after anesthesia,5 min after drug withdrawal,the RI levels were(0.67±0.10),(0.70±0.12),(0.72±0.17) and(0.69±0.09) respectively,Vs levels were(68.26±6.41) cm/s,(66.26±5.92) cm/s,(66.93±6.13) cm/s and(67.73±6.26) cm/s respectively,and Vd levels were(25.56±2.03) cm/s,(23.79±1.92) cm/s,(23.88±1.90) cm/s and(24.72±1.98) cm/s respectively.Before anesthesia,10 min after anesthesia,30 min after anesthesia,5 min after drug withdrawal,the RI levels were(0.68±0.11),(0.86±0.15),(0.88±0.17),(0.85±0.15) respectively in the control group,Vs levels were(68.45±6.43) cm/s,(62.51±5.28) cm/s,(62.65±5.73) cm/s and(63.27±6.04) cm/s respectively,and Vd levels were(25.54±2.04) cm/s,(21.01±1.43) cm/s,(21.57±1.62) cm/s and(22.28±1.70) cm/s respectively.Before anesthesia,there was no statistically significant difference in levels of RI,Vs and Vd between the two groups(P>0.05).At 10 and 30 min after anesthesia and 5 min after drug withdrawal,the RI levels in the experimental group was lower than those in the control group,and levels of Vs and Vd was higher than those in the control group.Their difference was statistically significant(P<0.05).Before anesthesia,there was no statistically significant difference in levels of Qmean,Wv,CP and DR between the two groups(P>0.05).At 10 and 30 min after anesthesia and 5 min after drug withdrawal,the Qmean level in the experimental group was higher than those in the control group,levels of Wv and CP was higher than those in the control group,and DR level was lower than those in the control group.Their difference was statistically significant(P<0.05).Before anesthesia,there was no statistically significant difference in levels of CERO2,CjvO2,Da-jvO2 between the two groups(P>0.05).At 10 and 30 min after anesthesia and 5 min after drug withdrawal,the levels of CERO2 and CjvO2 in the experimental group was higher than those in the control group,and Da-jvO2 levels was lower than that in the control group.Their difference was statistically significant(P<0.05).Conclusion Remifentanil shows less influence on hemodynamics of cerebral artery,cerebrovascular hemodynamics and cerebral blood oxygen of patients undergoing craniocerebral operation,and its safety is higher.