七氟醚联合瑞芬太尼维持麻醉对介入治疗颅内动脉瘤患者神经功能、认知功能、炎性因子的影响

Effects of Sevoflurane Combined with Rremifentanil on Neurologic Function,Cognitive Function and Inflammatory Factors in Patients with Intracranial Aneurysms Undergoing Interventional Therapy

目的:探讨七氟醚联合瑞芬太尼维持麻醉对介入治疗颅内动脉瘤(IA)患者神经功能、认知功能及炎性因子的影响。方法:选入2020年1月~2022年6月在我院接受介入手术治疗的IA患者80例,根据麻醉方式不同分为A组(七氟醚联合瑞芬太尼)和B组(丙泊酚联合瑞芬太尼),每组40例。评价两组患者的神经功能、认知功能、炎症因子水平等指标,并进行统计比较。结果:A组T1~T3时心率(HR)和平均动脉压(MAP)明显优于B组(P<0.05);A组术后24 h和术后7 d美国国立卫生研究院卒中量表(NIHSS)评分明显低于B组(P<0.05),易智能精神状态检查量表(MMSE)评分显著高于B组(P<0.05);A组术后24 h、术后3 d血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)和白细胞介素-6(IL-6)水平均明显低于B组(P<0.05);A组术后自主呼吸恢复时间、苏醒时间、拔管时间及拔管后躁动发生率较B组低(P<0.05);不良反应无差异(P>0.05)。结论:将七氟醚联合瑞芬太尼维持麻醉应用于介入治疗IA患者,可平稳血流动力学,改善术后神经功能及认知功能,降低炎症反应,提高麻醉苏醒质量。

Objective:To investigate the effects of sevoflurane combined with remifentanil on neurologic function,cognitive function and inflammatory factors in patients with intracranial aneurysms undergoing interventional therapy.Methods:80 patients with intracranial aneurysms who underwent interventional surgery in our hospital from January 2020 to June 2022 were selected and divided into group A(sevoflurane combined with remifentanil)and group B(propofol combined with remifentanil)according to different anesthesia methods,with 40 patients in each group.Neurological function,cognitive function and inflammatory factor level were compared between the two groups.Results:The heart rate(HR)and mean arterial pressure(MAP)of group A were better than those of group B from T1 to T3(P<0.05).The national institutes of health stroke scale(NIHSS)score of group A was significantly lower than that of group B at 24 h and 7 d after operation(P<0.05),and the mini-mental state examination(MMSE)score was higher than that of group B(P<0.05).Serum tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),and interleukin-6(IL-6)levels at 24 h and 3 d after operation in group A were lower than those in group B(P<0.05).The recovery time of spontaneous respiration,recovery time,extubation time and the incidence of agitation after extubation in group A were lower than those in group B(P<0.05).The adverse effects were not different(P>0.05).Conclusion:The application of sevoflurane combined with remifentanil maintenance anesthesia in interventional IA patients can smooth hemodynamics,improve postoperative neurological function and cognitive function,reduce inflammatory response,and improve the quality of anesthesia awakening.