瑞芬太尼联合丙泊酚用于脑出血微创引流术的麻醉效果观察

Observation on the anesthetic effect of remifentanil combined with propofol for minimally invasive drainage of cerebral hemorrhage

目的 探析瑞芬太尼联合丙泊酚用于脑出血微创引流术的麻醉效果。方法 116例脑出血微创引流术患者,依据入院单双号分为研究组和对比组,每组58例。对比组患者给予芬太尼联合丙泊酚麻醉,研究组患者给予瑞芬太尼联合丙泊酚麻醉。对比两组患者的基础指标(手术时间、出血量、苏醒时间、自主呼吸恢复时间及丙泊酚使用剂量),麻醉前后免疫细胞水平,手术期间颅脑损伤标志物水平。结果 两组患者手术时间、出血量对比,差异无统计学意义(P>0.05)。研究组患者苏醒时间(39.56±4.78)min、自主呼吸恢复时间(6.32±0.28)min均短于对比组的(59.61±6.32)、(7.22±0.37)min,丙泊酚使用剂量(124.16±23.18)mg低于对比组的(298.44±35.60)mg,差异有统计学意义(P<0.05)。麻醉前,两组患者CD3^(+)、CD4^(+)和CD8^(+)水平对比,差异无统计学意义(P>0.05)。麻醉后,研究组患者CD3^(+)(59.96±4.52)%、CD4^(+)(32.16±3.42)%、CD8^(+)(26.15±5.23)%均明显优于对比组的(52.13±4.15)%、(30.15±3.07)%、(30.31±5.48)%,差异有统计学意义(P<0.05)。术中,两组患者神经元特异性烯醇化酶、血清胶质纤维酸性蛋白及组织因子对比,差异无统计学意义(P>0.05)。术后,研究组患者神经元特异性烯醇化酶(28.46±4.15)ng/ml、血清胶质纤维酸性蛋白(2.11±1.31)pg/ml、组织因子(2.93±0.61)ng/L低于对比组的(36.64±4.87)ng/ml、(4.37±1.52)pg/ml、(3.55±0.72)ng/L,差异有统计学意义(P<0.05)。结论 瑞芬太尼联合丙泊酚用于脑出血微创引流术的麻醉效果确切且理想,可给予广泛的临床推广及应用。

Objective To analyze the anesthetic effect of remifentanil combined with propofol for minimally invasive drainage of cerebral hemorrhage.Methods 116 patients with cerebral hemorrhage underwent minimally invasive drainage were divided into a study group and a comparison group according to their odd and even numbers on admission,with 58 cases in each group.Patients in the control group were given fentanyl combined with propofol,and patients in the study group were given remifentanil combined with propofol.The basic indexes(operative time,blood loss,recovery time,time to the return of spontaneous respiration and dose of propofol),the level of immune cells before and after anesthesia,and the level of markers of craniocerebral injury during surgery were compared between the two groups.Results There was no statistically significant difference in operative time and blood loss between the two groups(P>0.05).The recovery time of patients in the study group was(39.56±4.78)min and the time to the return of spontaneous respiration was(6.32±0.28)min,which were shorter than those of(59.61±6.32)and(7.22±0.37)min in the control group;the dose of propofol in the study group was(124.16±23.18)mg,which was lower than that of(298.44±35.60)mg in the control group;the difference was statistically significant(P<0.05).Before anesthesia,there was no statistically significant difference in the levels of CD3^(+),CD4^(+) and CD8^(+) between the two groups(P>0.05).After anesthesia,the study group had CD3^(+) of(59.96±4.52)%,CD4^(+) of(32.16±3.42)%and CD8^(+) of(26.15±5.23)%,which were significantly better than those of(52.13±4.15)%,(30.15±3.07)%and(30.31±5.48)%in the control group.The difference was statistically significant(P<0.05).During the surgery,there was no statistically significant difference in neuron-specific enolase,serum glial fibrillary acidic protein and tissue factors between the two groups(P>0.05).After the surgery,the levels of neuron-specific enolase in the study group was(28.46±4.15)ng/ml,the serum glial fibrillary acidic protein was(2.11±1.31)pg/ml and the tissue factor was(2.93±0.61)ng/ml,which were lower than those of(36.64±4.87)ng/ml,(4.37±1.52)pg/ml and(3.55±0.72)ng/L in the control group.The difference was statistically significant(P<0.05).Conclusion The anesthesia effect of remifentanil combined with propofol for minimally invasive drainage of cerebral hemorrhage is definite and ideal,and can be given a wide range of clinical promotion and application.