目的 分析丙泊酚联合芬太尼麻醉对重型颅脑损伤急诊手术患者的脑血流动力学及认知功能的影响.方法 回顾性分析2014年1月至2017年2月收治的伤后24 h内的急性重型颅脑损伤72例患者,随机分为观察组和对照组各36例.对照组均气管插管后吸入异氟醚维持麻醉,观察组均给予芬太尼与丙泊酚联合麻醉处理.比较两组患者诱导前(T0)、诱导后1 min(T1)、插管后5 min(T2)、插管后10 min(T3)时间点的脑血流动力学参数、心率(HR)及平均动脉压(MAP),此外采用简易智能精神状态量表(MMSE)评定两组患者手术前后的神经精神功能,并通过MMSE评分认定两组患者认知功能缺损(POCD)情况.结果 两组患者T1~T3期较同组T0期Qmean和Vmean均出现不同程度的变化,对照组显著降低(P0.05);两组PI指数和RI指数均较T0期显著升高(P0.05);T1期两组患者的HR和MAP均较T0期显著降低(P0.05),组间同期比较差异亦无统计学意义(P>0.05).相较于术前,术后1 d两组的MMSE评定均明显减低(P0.05).术后1 d,观察组POCD的发生率明显低于对照组(P 0. 05). PI and RI in two groups were comparable to a significant rise in period (P 0. 05). Compared with those of two groups at the stage t0,HR and MAP of them at the stage T1 were significantly decreased (P 0. 05). Compared with preoperative,the MMSE e-valuation in two groups of postoperative 1d were significantly lower (P 0. 05). The incidence of POCD in the observation group postoperative 1 day was significantly less than that of the control group (P < 0. 05). Postoperative 1 week,there were 3 POCD patients in the control group but none in observation group. Conclusion The clinical anesthesia effect of combination - application of propofol and fentanyl is perfect for stable profita-bly the cerebral blood flow dynamics of patients with severe craniocerebral injury,the influence on cognitive function is smaller,and can effectively reduce the occurrence of postoperative cognitive dysfunction. Therefore,it is worthy of popularization and application.
展开▼
