异丙酚联合瑞芬太尼靶控输注在颅脑外伤手术患者中的应用

Application of Target-Controlled Infusion of Propofol Combined with Remifentanil in Patients Undergoing Craniocerebral Trauma Surgery

目的 观察异丙酚联合瑞芬太尼靶控输注(TCI)对颅脑外伤手术患者的应用效果。方法 选取2020年1月至2023年1月医院收治的136例急诊手术颅脑外伤患者,依据入院顺序编号,后按单双号法分为观察组(单号)和对照组(双号),各68例。观察组接受异丙酚联合瑞芬太尼TCI,对照组接受恒速输注异丙酚联合瑞芬太尼。记录两组术中血流动力学指标[平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO_(2))]、手术及拔管时间、脑氧代谢[颈内静脉血氧饱和度(SjvO_(2)),动脉和颈内静脉血氧含量差(Da-jvO_(2))]、认知功能[简易智能精神状态量表(MMES)评分、术后认知功能障碍(POCD)]。结果 两组MAP及HR值交互效应、处理主效应和时间主效应有统计学意义(P<0.05),进一步两两比较,观察组在T_(1)时刻MAP水平高于对照组(P<0.05);两组SpO_(2)水平交互效应、处理主效应和时间主效应均无统计学意义(P>0.05)。观察组手术时间及拔管时间较对照组短(P<0.05)。两组SjvO_(2)和Da-jvO_(2)交互效应、处理主效应和时间主效应有统计学意义(P<0.05),进一步两两比较,观察组在麻醉诱导后30 min和麻醉后1 h时SjvO_(2)和Da-jvO_(2)水平差异有统计学意义(P<0.05)。术后3 d,两组MMES评分均较术前降低(P<0.05),且观察组高于对照组(P<0.05);术后7、30 d时两组MMES评分与术前比较差异均无统计学意义(P>0.05)。两组术后3 d POCD发生率最高,术后3 d到1个月POCD发生率逐渐下降(P>0.05),两组术后各时间点POCD发生率组间差异无统计学意义(P>0.05)。结论 异丙酚联合瑞芬太尼TCI可稳定颅脑外伤患者机体局部代谢状态及血液供应,改善患者认知情况。

Objective To observe the application effects of target-controlled infusion(TCI)of propofol combined with remifentanil on patients with craniocerebral trauma surgery.Methods A total of 136 patients with emergency surgical head injury admitted to the hospital from January 2020 to January 2023 were selected and numbered according to the order of admission.They were then divided into an observation group(single number)and a control group(double number)using a single or double number method,with 68 patients in each group.The observation group received propofol combined with remifentanil TCI,while the control group received constant rate infusion of propofol combined with remifentanil.The intraoperative hemodynamics[mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO 2)],surgical time and extubation time,cerebral oxygen metabolism[jugular venous oxygen saturation(SjvO 2),arterial venous oxygen content difference(Da-jvO 2)]and cognitive function[mini-mental state examination(MMES)score,incidence rate of postoperative cognitive dysfunction(POCD)]were recorded in the two groups.Results The interaction effect,processing main effect,and time main effect of MAP and HR values between the two groups were statistically significant(P<0.05).Further pairwise comparison showed that the MAP level in the observation group was higher than that in the control group at T 1(P<0.05).There was no statistically significant interaction effect,treatment main effect,and time main effect between the two groups of SpO 2 levels(P>0.05).The surgical time and extubation time in the observation group were shorter than those in the control group(P<0.05).The interaction effect,treatment main effect,and time main effect of SjvO 2 and Da-jvO 2 between the two groups were statistical significant(P<0.05).Further pairwise comparison showed that there was a statistically significant difference in the levels of SjvO 2 and Da-jvO 2 between the observation group at 30 minutes after anesthesia induction and 1 hour after anesthesia(P<0.05).On the 3rd day after surgery,the MMES scores of both groups decreased compared to before surgery(P<0.05),and the observation group was higher than the control group(P<0.05).There was no statistically difference in the MMES scores between the two groups at 7 and 30 days after surgery compared to before surgery(P>0.05).The incidence of POCD was the highest in the two groups at 3 days after surgery,and gradually decreased from 3 days to 1 month after surgery(P>0.05).There was no statistically difference in the incidence of POCD between the two groups at different time points after surgery(P>0.05).Conclusion Propofol combined with remifentanil TCI can stabilize the local metabolic status and blood supply of patients with traumatic brain injury,and improve their cognitive status.