丙泊酚联合盐酸瑞芬太尼在重型颅脑损伤急诊手术中的应用价值

Application Value of Propofol Plus Remifentanil Hydrochloride in Emergency Surgery for Severe Craniocerebral Injury

目的:探究丙泊酚联合盐酸瑞芬太尼在重型颅脑损伤急诊手术中的应用价值。方法:选取2019年4月—2022年4月成武县人民医院收治的重型颅脑损伤急诊手术患者60例作为研究对象,随机分为两组,各30例。对照组应用丙泊酚联合硝普钠麻醉,观察组应用丙泊酚联合盐酸瑞芬太尼麻醉。比较两组患者各时间点血气指标、血清S-100β水平、脑组织氧分压(PbtO_(2))和颅内压(ICP)。结果:术后2 h(T_(2))~手术结束时(T_(4)),观察组心率低于对照组,差异有统计学意义(P<0.001)。T_(2)~T_(4)时,两组血清S-100β水平高于术后即刻,硬脑膜缝合时、T_(4)时,观察组血清S-100β水平低于对照组,差异有统计学意义(P<0.05)。术后3 h,观察PbtO_(2)高于对照组,ICP低于对照组,差异有统计学意义(P<0.001)。结论:重型颅脑损伤急诊手术中应用丙泊酚联合盐酸瑞芬太尼麻醉,有助于改善患者心率、血清S-100β、PbtO_(2)、ICP水平,起到保护脑组织的作用。

Objective:To explore the application value of propofol plus remifentanil hydrochloride in the emergency surgery for severe craniocerebral injury.Methods:A total of 60 patients undergoing emergency surgery for severe craniocerebral injury in People's Hospital of Chengwu County from April 2019 to April 2022 were selected as the study subjects.They were randomly divided into two groups,with 30 cases each.The control group was anesthetized with propofol combined with sodium nitroprusside,and the observation group was anesthetized with propofol combined with remifentanil hydrochloride.The blood gas index,serum S-100βlevel,partial pressure of oxygen in brain tissue(PbtO_(2))and intracranial pressure(ICP)at each time point were compared between the two groups.Results:From 2 h after surgery(T_(2))to the end of surgery(T_(4)),the heart rate in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.001).During T_(2)-T_(4),the serum S-100βlevel in the two groups was higher than that immediately after surgery,and when the dura mater was sutured and at T_(4),the serum S-100βlevel in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).At 3 h after surgery,PbtO_(2) in the observation group was higher than that in the control group,ICP in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.001).Conclusion:The application of propofol plus remifentanil hydrochloride in the emergency surgery for severe craniocerebral injury helps to improve the heart rate,serum S-100β,PbtO_(2),and ICP levels,and effectively protect the brain tissue.