目的:探讨麻醉快速诱导中使用阿片类药物和肌肉松弛剂对颅内肿瘤患者颅内压和脑灌注压的影响.方法:将40例术前颅内压轻度增高的颅内幕上肿瘤患者随机分为芬太尼+罗库溴铵组(FR组)、芬太尼+琥珀酰胆碱组(FS组)、舒芬太尼+罗库溴铵组(SR组)和舒芬太尼+琥珀酰胆碱组(SS组)组.观察全麻诱导前至硬脑膜切开后颅内压、脑灌注压、呼吸末二氧化碳、气道峰压和中心静脉压的变化.结果:与诱导前相比,麻醉诱导后各组患者颅内压显著升高,脑灌注压显著下降(均P<0.05).诱导剂量的琥珀酰胆碱和罗库溴铵对麻醉诱导后颅内压的影响无显著性差异;复合使用舒芬太尼的两组患者脑灌注压值较两组复合使用芬太尼组患者降低更为明显.结论:颅内幕上肿瘤患者麻醉诱导后颅内压升高与使用阿片类药物有关,而非快速起效肌肉松弛剂所引起.诱导剂量的舒芬太尼比芬太尼有更强的降低脑灌注压的作用,在颅脑外科麻醉诱导中应谨慎使用.%Objective:To investigate the effects of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) by using opiates and fast-onset neuromuscular blockers in the induction during supratentorial craniotomy, and to provide evidences for choosing induction drugs in the anesthesia of neurosurgery. Methods: Forty cases of supratentorial tumor with mild increased ICP were randomly allocated into 4 groups, in which cross- matched fentanyl, sufentanil and succinylcholine, rocuronium were used in the induction of craniotomy. The changes of ICP and CPP were analyzed during the period of before-induction to open dura. Results:The ICP was significantly increased and CPP was significantly decreased after the induction in the all of four groups. There were no statistic difference in ICP change between succinylcholine and rocuronium induction; In the two groups in which the sufentanil were used, the CPP decreased much lower than those in the two groups in which the fentanyl were used. Conclusions:The ICP increasing of supratentorial tumor patients with decreased intracranial compliance after anesthesia induction is related to opiates, whereas is not necessarily caused by fast-onset neuromuscular blockers. The induction dose of sufentanil has stronger effects of decreasing CPP than that of fentanyl, which should be cautiously used in the anesthesia for neurosurgery.
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