不同异丙酚输注模式联合瑞芬太尼对颅内假性动脉瘤介入术患者血流动力学的影响

Effects of different propofol infusion modes combined with remifentanil on hemodynamics of patients undergoing intracranial pseudoaneurysm intervention surgery

目的探讨不同异丙酚输注模式联合瑞芬太尼对颅内假性动脉瘤介入术患者血流动力学的影响。方法选取2018年5月至2020年5月间在郑州大学附属洛阳中心医院神经内科进行颅内假性动脉瘤介入术的80例患者作为研究对象,并采用简单随机分组法将研究对象分为对照组和观察组,每组各40例。对照组采用恒速输注异丙酚联合瑞芬太尼,观察组采用血浆靶控输注异丙酚联合瑞芬太尼。比较两组患者的手术情况、及其在麻醉诱导前(T0)、气管插管前(T1)、气管插管时(T2)、气管插管3 min后(T3)的血流动力学参数及不良反应发生率。结果观察组术中异丙酚用药量低于对照组(P<0.05)。重复测量方差分析显示,心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、收缩压(systolic blood pressure,SBP)组间、时间及交互差异均有统计学意义(P<0.05)。简单效应分析显示,观察组和对照组在T0、T2、T3时的HR、MAP、SBP比较,差异无统计学意义(P>0.05);观察组T1的HR、MAP、SBP均高于对照组(P<0.05)。观察组的不良反应发生率明显低于对照组(P<0.05)。结论血浆靶控输注异丙酚联合瑞芬太尼麻醉可使行颅内假性动脉瘤介入术患者的血流动力学更加平稳,降低不良反应的发生率。

Objective To explore the effects of different propofol infusion modes combined with remifentanil on hemodynamics of patients undergoing intracranial pseudoaneurysm intervention surgery.Methods 80 patients undergoing intracranial pseudoaneurysm intervention surgery in the neurology department of Luoyang Central Hospital Affiliated it enrolled to Zhengzhou University as the research objects between May 2018 and May 2020.According to simple random grouping method,the patients were divided into the control group and observation group,40 cases in each group.The control group was given constant-rate infusion of propofol combined with remifentanil,while observation group was given plasma target-controlled infusion of propofol combined with remifentanil.The surgical situations,hemodynamics parameters and the incidence of adverse reactions were compared between the two groups.Results The intraoperative dosage of propofol in observation group was lower than that in the control group(P<0.05).Repeated measures analysis of variance showed that there were significant differences in heart rate(HR),mean arterial pressure(MAP)and systolic blood pressure(SBP)in terms of between-group,time and their interaction effect(P<0.05).Simple effect analysis showed that there was no significant difference in HR,MAP or SBP between the two groups before anesthesia induction(T 0),at tracheal intubation(T 2)and 3 minutes after tracheal intubation(T 3)(P>0.05).Before tracheal intubation(T 1),HR,MAP and SBP in observation group were higher than those in control group(P<0.05).The incidence of adverse reactions in observation group was lower than that in control group(P<0.05).Conclusion Plasma target-controlled infusion of propofol combined with remifentanil anesthesia can better stabilize hemodynamics of patients undergoing intracranial pseudoaneurysm intervention surgery and reduce the incidence of adverse reactions.