丙泊酚联合舒芬太尼对脑胶质瘤手术患者血流动力学及脑氧代谢的影响

Effect of propofol combined with sufentanil on hemodynamics and cerebral oxygen metabolism in patients undergoing surgery of brain glioma

目的观察丙泊酚联合舒芬太尼对脑胶质瘤手术患者血流动力学及脑氧代谢的影响。方法前瞻性研究。抽取2021年6月至2023年6月于河南科技大学第二附属医院拟行脑胶质瘤开颅切除术治疗的84例患者为研究对象,采用随机数字表法分为对照组与观察组,每组42例。对照组应用丙泊酚联合芬太尼麻醉,观察组应用丙泊酚联合舒芬太尼麻醉。比较两组患者麻醉诱导前30 min(T0)、术中切开硬脑膜时(T1)、完全切除肿瘤时(T2)、手术结束时(T3)血流动力学指标[心率(HR)、平均动脉压(MAP)]、脑氧代谢指标[中心静脉血氧饱和度(ScVO_(2))、颈内静脉血氧饱和度(SjVO_(2))]及脑损伤指标[血清神经元特异性烯醇化酶(NSE)、S100β蛋白]。统计两组术后48 h内麻醉不良反应发生情况。结果与T0时相比,两组T1、T2、T3时HR、MAP均降低,且观察组T1、T2、T3时HR、MAP均低于对照组(P均<0.05)。T1、T2、T3时,两组ScVO_(2)、SjVO_(2)均较T0时提高,且观察组T1、T2、T3时ScVO_(2)、SjVO_(2)均高于对照组(P均<0.05)。T1、T2、T3时,两组血清NSE、S100β均较T0时提高,但观察组T1、T2、T3时血清NSE、S100β均低于对照组(P均<0.05)。术后48 h内,观察组麻醉不良反应总发生率(7.14%,3/42)低于对照组(23.80%,10/42),P<0.05。结论丙泊酚联合舒芬太尼麻醉有利于稳定脑胶质瘤手术患者血流动力学,改善患者脑氧代谢,减轻术中脑损伤,安全性良好。

ObjectiveTo observe the effects of propofol combined with sufentanil on hemodynamics and cerebral oxygen metabolism in patients undergoing surgery of brain glioma.MethodsThis study was a prospective study that included 84 patients who were scheduled to undergo craniotomy for glioma of the brain in the Second Affiliated Hospital of Henan University of Science and Technology from June 2021 to June 2023 as the study subjects.And they were divided into a control group and an observation group using a random number table method,with 42 cases in each group.The control group was anaesthetized with propofol combined with fentanyl,while the observation group was anaesthetized with propofol combined with sufentanil.The hemodynamic indexes,including heart rate(HR)and mean arterial pressure(MAP),cerebral oxygen metabolism indexes,including central venous blood oxygen saturation(ScVO 2)and jugular venous bulb oxygen saturation(SjVO_(2)),and brain injury indexes,including serum neuron-specific enolase(NSE)and S100βprotein,of the two groups were recorded at 30 min before anesthesia induction(T0),at the time of intraoperative dural incision(T1),after completing tumor resection(T2),and at the end of surgery(T3),and these indexes were compared between the two groups.The incidences of adverse reactions of anesthesia within 48 hours after operation of the two groups were statistically analyzed.ResultsIn the two groups,the HR and MAP at T1,T2,and T3 decreased compared with these indexes at T0(P<0.05);and the observation group had lower HR and MAP at T1,T2,and T3 compared with the control group(P<0.05).In the two groups,the levels of ScVO_(2) and SjVO_(2) at T1,T2,and T3 were higher than those at T0(P<0.05);and the ScVO_(2) and SjVO_(2) levels at T1,T2,and T3 in the observation group were higher than those in the control group(P<0.05).The serum NSE and S100βat T1,T2 and T3 in the two groups were higher than those at T0,but the serum NSE and S100βat T1,T2 and T3 in the observation group were lower than those in the control group(P<0.05).The total incidence of adverse reactions to anesthesia within 48 hours after surgery in the observation group(7.14%,3/42)was lower than that in the control group(23.80%,10/42),P<0.05.ConclusionsPropofol combined with sufentanil anesthesia is beneficial for stabilizing hemodynamics,improving brain oxygen metabolism,reducing intraoperative brain injury,and ensuring good safety in patients undergoing surgery of brain glioma.