丙泊酚或异氟醚对重度脑损伤患者Barthel指数的影响比较

摘要

目的 比较丙泊酚或异氟醚麻醉对硬膜外血肿重度脑损伤患者Baahel指数的影响.方法 行硬膜外血肿清除术重度脑损伤患者84例,随机分为A、B两组,每组42例;两组麻醉诱导方式相同,麻醉维持:A组靶控输注丙泊酚2.5～3.0μg/ml(血药浓度),B组吸入异氟醚1.5％～2.0％,两组均靶控输注瑞芬太尼4 ng/ml(效应室浓度);记录两组患者麻醉前(T0)、诱导后2 min(T1)、插管后10min(T2)、30 min(T3)心率(HR)、动脉血二氧化碳分压(PaCO2)、动脉血氧(CaO2)、血氧饱和度(SaO2)以及S100B蛋白浓度,评价术后1个月两组Barthel指数.结果 诱导后A组HR为(76.41±12.49)次/min、CaO2为(111.98± 15.64) ml/L,诱导后B组HR为(82.34±12.45)次/min,CaO2(109.41±17.12)ml/L,与A组比较,HR显著升高,CaO2显著降低(均P＜0.05);术后两组S100B蛋白浓度均有上升,但A组[(1.25±0.78)μg/L]显著低于B组[(1.61±0.42)μg/L],P＜0.05;A组术后Barthel指数优良率为57.14％,较B组的30.95％高(P＜0.05).结论 丙泊酚较异氟醚对重度颅脑损伤患者能降低脑氧代谢率,减少脑神经损伤,更具有脑保护作用.%Objective To explore the effect of propofol versus isoflurane on Barthel index in patients with severe brain injury.Methods Eighty-four patients with severe brain injury who undergoing the clearance of epidural hematoma were randomized into group A and group B,42 cases for each group.Both groups were given the same anesthesia induction.Group A used target controlled infusion of propofol 2.5-3.0μg/ml (blood concentration) for the maintenance of anesthesia,while group B inhaled isoflurane 1.5％-2.0％ for the maintenance of anesthesia.Both groups were given target controlled infusion of remifentanil 4 ng/ml (effect compartment concentration).The heart rate (HR),partial pressure of arterial carbon dioxide (PaCO2),arterial oxygen (CaO2),oxygen saturation (SaO2),and concentrations of S 100B protein were recorded before anesthesia (T0) and 2 (T1),10 (T2),and 30 min (T3) after intubation.The Barthel index of both groups was evaluated 1 month after operation.Results After induction,the HR and CaO2 were (76.41 ± 12.49) beats/min,and (111.98±15.64) ml/L in group A and were (82.34±12.45) beats/min and (109.41±17.12) ml/L in group B (P ＜ 0.05).After operation,the concentration of S100B protein increased in both groups,but the the concentration in group A [(1.25±0.78)μtg/L] was significantly lower than that in B group [(0.05±0.42)μg/L] (P ＜ 1.61).The excellent and good rate of Barthel index in group A after operation was higher than that in group B (57.14％ vs.30.95％,P ＜ 0.05).Conclusion Compared with isoflurane anesthesia,propofol anesthesia can reduce the rate of cerebral oxygen metabolism and brain damage in patients with severe brain injury.It is of protective effect on brain.