七氟醚对开颅血肿清除术患者的麻醉效果及血流动力学的影响研究

Effect of sevoflurane on patients undergoing craniotomy and their DBP,SBP,and SPO_(2)

目的观察七氟醚在开颅血肿清除术中的麻醉效果及对舒张压(diastolic blood pressure,DBP)、收缩压(systolic blood pressure,SBP)、血氧饱和度(pulse oxygen saturation,SpO_(2))水平的影响。方法选取2017年5月至2020年5月在本院接受开颅血肿清除术的患者80例为研究对象,根据其麻醉方式的不同分为两组,各40例。对照组男23例,女17例,年龄(40.12±3.54)岁;观察组男24例,女16例,年龄(40.08±4.02)岁。对照组给予瑞芬太尼、丙泊酚静脉持续泵注,观察组给予瑞芬太尼维持麻醉,七氟醚吸入;观察两组患者应激指标、血流动力学指标、不良反应发生率的差异。结果麻醉前,两组患者应激指标比较,差异均无统计学意义(均P>0.05);手术后2 h,观察组血糖、皮质醇、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平分别为(4.58±0.82)mmol/L、(4.12±0.57)μg/L、(19.46±3.62)pg/ml,均低于对照组(5.56±1.11)mmol/L、(6.34±1.12)μg/L、(25.03±4.23)pg/ml,差异均有统计学意义(均P<0.05);麻醉前、手术后2 h,两组患者SpO_(2)指标比较,差异均无统计学意义(均P>0.05);麻醉前,两组患者SBP、DBP指标比较,差异均无统计学意义(均P>0.05);手术后2 h,观察组DBP、SBP水平分别为(86.24±3.05)mmHg(1 mmHg=0.133 kPa)、(129.17±3.01)mmHg,均低于对照组(92.63±2.33)mmHg、(136.34±2.98)mmHg,差异均有统计学意义(均P<0.05);两组患者不良反应发生率比较,差异无统计学意义(P>0.05);观察组麻醉满意率为97.5%(39/40),明显高于对照组82.5%(33/40),差异有统计学意义(P<0.05)。结论七氟醚在开颅血肿清除术中的麻醉效果较好,对患者血流动力学影响小,具有良好的应用价值。

Objective To observe the anesthetic effect of sevoflurane in craniotomy hematoma clearance and its effect on diastolic blood pressure(DBP),systolic blood pressure(SBP),and pulse oxygen saturation(SpO_(2)).Methods From May,2017 to May,2020,80 patients who underwent craniotomy at our hospital were divided into a control group and an observation group according to their anesthetic methods.There were 23 males and 17 females in the control group;they were(40.12±3.54)years old.There were 24 males and 16 females in the observation group;they were(40.08±4.02)years old.The control group were given remifentanil and propofol intravenously and continuously.The observation group were given remifentanil maintenance anesthesia and inhaled sevoflurane.The stress indicators,hemodynamic indicators,and incidences of adverse reactions were compared between the two groups.Results There were no statistical differences in stress indicators between the two groups before the anesthesia(all P>0.05).Two hours after the operation,the levels of blood glucose,cortisol,and tumor necrosis factor-α(TNF-α)were lower in the observation group than in the control group[(4.58±0.82)mmol/L vs.(5.56±1.11)mmol/L,(4.12±0.57)μg/L vs.(6.34±1.12)μg/L,and(19.46±3.62)pg/ml vs.(25.03±4.23)pg/ml;all P<0.05].There were no statistical differences in SBP and DBP between the two groups before the anesthesia.Two hours after the operation,the DBP and SBP were lower in the observation group than in the control group[(86.24±3.05)mmHg(1 mmHg=0.133 kPa)vs.(92.63±2.33)mmHg and(129.17±3.01)mmHg vs.(136.34±2.98)mmHg;both P<0.05].There was no statistical difference in the incidence of adverse reactions between the two groups(P>0.05).The satisfaction with anesthesia was significantly higher in the observation group than in the control group[97.5%(39/40)vs.82.5%(33/40);P<0.05].Conclusion Sevoflurane has a good anesthetic effect and little influence on hemodynamics during craniotomy,so it has a good application value.