大脑皮质功能区肿瘤切除术中应用丙泊酚联合瑞芬太尼或舒芬太尼对丙泊酚用量及认知水平的影响

Effect of Propofol Combined with Remifentanil or Sufentanil on the Dosage and Cognitive Level of Propofol in Resection of Cerebral Cortex Tumor

目的:探究大脑皮质功能区肿瘤切除术中应用丙泊酚联合瑞芬太尼或舒芬太尼对丙泊酚用量、认知水平的影响。方法:选取2016年1月至2019年11月在本院接受开颅手术的大脑皮质功能区肿瘤患者70例,按照简单随机分组分为瑞芬太尼组(RF组)以及舒芬太尼(SF组),各35例。RF组通过丙泊酚联合瑞芬太尼进行静脉麻醉,SF组则是通过丙泊酚联合舒芬太尼进行静脉麻醉。观测比较两组患者监测诱导前(T 0)、插管时(T 1)、插管后1min(T 2)、插管后5min(T 3)、拔管后(T 4)的丙泊酚血浆靶浓度、收缩压(SBP)、舒张压(DBP)以及心率(HR);观察比较两组患者的认知水平变化。结果:两组患者不同时间点丙泊酚血浆靶浓度相比较,RF组要明显低于SF组(P<0.05),拔管后,RF组的丙泊酚血浆靶浓度、SBP、DBP及HR均要比SF组的低(P<0.05);两组患者术后清醒后,RF组的MMSE评分要比SF组的高(P<0.05),而术后5d,两组患者MMSE评分均已恢复(P>0.05);两组患者的不良反应率比较,RF组(17.14%)要明显低于SF组(40%)(P<0.05)。结论:在大脑皮质功能区肿瘤切除术中,应用丙泊酚联合瑞芬太尼相较于丙泊酚联合舒芬太尼更能降低麻醉中丙泊酚血浆靶浓度,可适当的减少丙泊酚用量,有效降低患者术后认知功能障碍程度。

Objective:To investigate the effect of propofol combined with remifentanil or sufentanil on propofol dosage and cognitive level in remifentanil.Methods:From January 2016 to November 2019,70 patients with cerebral cortical functional area tumors underwent craniotomy in our hospital were randomly divided into 35 cases of remifentanil group(group RF)and sufentanil group(group SF).Group RF was anesthetized intravenously with propofol combined with remifentanil.Group SF was anesthetized intravenously with propofol combined with sufentanil.The pre-induction(T0),during intubation(T1),1 min after intubation(T2),5 min after intubation(T3),After extubation(T4)propofol plasma target concentration,systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were observed and compared between the two groups.The cognitive changes of the two groups were observed and compared.Results:Compared with the target concentration of propofol at different time points in the two groups,group RF was significantly lower than group SF(P<0.05).After extubation,the plasma concentration of propofol in group RF was lower than that in group SF(P<0.05).The MMSE scores in group RF were higher than those in group SF(P<0.05)after 5 days after operation(P>0.05).The adverse reaction rate of group RF(17.14%)was significantly lower than that of SF group(40%)(P<0.05).Conclusion:Compared with propofol combined with sufentanil,propofol combined with remifentanil can reduce the plasma target concentration of propofol in anesthesia,reduce the dosage of propofol appropriately,and effectively reduce the degree of cognitive impairment after operation.