七氟醚与丙泊酚联合瑞芬太尼麻醉在神经外科手术中的应用效果比较

摘要

目的 比较七氟醚与丙泊酚联合瑞芬太尼麻醉在神经外科手术中的应用效果.方法 将115例择期行神经外科手术患者随机分为七氟醚组58例和丙泊酚组57例.七氟醚组患者给予七氟醚联合瑞芬太尼进行麻醉,丙泊酚组患者给予丙泊酚联合瑞芬太尼进行麻醉.记录两组患者麻醉前(T0)、气管插管时(T1)、去骨瓣时(T2)、麻醉维持时(T3)、手术结束时(T4)、拔管时(T5)的SBP、DBP、心率.比较两组患者麻醉前及手术结束时血浆皮质醇、促肾上腺皮质激素(ACTH)及血糖浓度.记录两组患者苏醒所需时间、拔管所需时间、术中及术后不良反应发生情况.结果 两组T1~T4SBP、DBP及心率均低于T0(P<0.05),两组间SBP、DBP及心率差异均无统计学意义(P>0.05),分组与时间均无交互效应(P>0.05).手术结束时,两组皮质醇、ACTH及血糖浓度均高于麻醉前,但丙泊酚组皮质醇、ACTH及血糖浓均低于七氟醚组(均P<0.05).七氟醚组苏醒所需时间及拔管所需时间均长于丙泊酚组(P<0.05).两组术中低血压、高血压及术后寒战、抽搐发生率比较,差异均无统计学意义(P>0.05),但丙泊酚组术中脑水肿发生率及术后恶心呕吐发生率均低于七氟醚组(P <0.05).结论 两种麻醉方案对神经外科手术患者循环系统的抑制作用相似,但丙泊酚联合瑞芬太尼能够更有效抑制患者围术期应激反应,降低术中脑水肿及术后恶心呕吐的发生风险,促进患者早期苏醒.%Objective To compare the effects of sevoflurane and propofol combined with remifentanil applied to neurosurgical operations.Methods A total of 115 patients undergoing elective neurosurgical operations were randomly divided into sevoflurane group (58 cases) and propofol group(57 cases).Patients in the sevoflurane group were given sevoflurane combined with remifentanil for anesthesia, while in the propofol group were given propofol combined with remifentanil.SBP,DBP and heart rate were recorded in both groups before anesthesia(T0),at the moment of tracheal intubation(T1),during bony flap removal(T2),during anesthesia maintenance(T3),at the end of operation(T4) and at the moment of extubation(T5).The concentrations of plasma cortisol,adrenocorticotropic hormone(ACTH) and blood glucose were compared between the two groups before anesthesia and at the end of operation.The recovery time,the extubation time, and the incidence of intraoperative and postoperative adverse reactions were recorded in both groups.Results SBP,DBP and heart rate were lower at T1-T4in both groups compared to those at T0(P<0.05),there was no significant difference in the SBP,DBP or heart rate between the two groups(P>0.05),and no interaction effects were found between group and time(P>0.05).At the end of surgery,the levels of cortisol,ACTH and blood glucose in both groups were higher than those before anesthesia,and the levels of cortisol,ACTH and blood glucose in the propofol group were lower than those in the sevoflurane group(P<0.05).The recovery time and extubation time in the sevoflurane group were longer than those in the propofol group(P<0.05).There was no significant difference in the incidence rate of hypotension,hypertension,postoperative chills or convulsions between the two groups(P>0.05),but the incidence rates of intraoperative encephaledema and postoperative nausea and vomiting in the propofol group were lower than those in the sevoflurane group(P<0.05). Conclusion The two anesthesia regimens have similar inhibitory effects on the circulatory system of patients undergoing neurosurgical operations,however,propofol combined with remifentanil can inhibit perioperative stress response and reduce the risks of intraoperative encephaledema and postoperative nausea and vomiting more effectively,and it is conducive to early recovery of the patients as well.