异丙酚或七氟醚联合瑞芬太尼靶控输注对脑组织氧代谢影响的对比研究  

Effects of target-controlled infusion of propofol or sevoflurane combined with remifentanil on cerebral oxygen metabolism:a comparison study

作　　者：普隽[1] 陈巍[1] 王亚楠[1] 夏建华 刘虎[1] 

机构地区：[1]第二军医大学长征医院麻醉科,上海200003 [2]解放军411医院麻醉科,上海200081

出　　处：《第二军医大学学报》2014年第7期804-807,共4页Academic Journal of Second Military Medical University

摘　　要：目的比较择期颅脑肿瘤患者麻醉过程中,异丙酚与七氟醚分别复合瑞芬太尼对脑组织氧代谢的影响,为临床用药提供参考。方法采用随机、双盲对照研究,纳入拟开展择期颅内肿瘤手术患者为研究对象,分为异丙酚+瑞芬太尼静脉靶控输注组(PR组,n=30)和七氟醚+瑞芬太尼静吸复合组(SR组,n=30)。观察指标包括:麻醉期间不同时间点患者的血流动力学指标、手术麻醉时间、颈静脉球血氧饱和度(SjvO2)及脑动静脉血氧含量差(Da-jvO2)等。结果两组患者血流动力学、麻醉手术时间差异无统计学意义;与PR组相比,SR组SjvO2较高,而Da-jvO2则较低(P<0.01)。结论异丙酚或七氟醚复合瑞芬太尼麻醉均可安全用于颅脑肿瘤患者手术,前者利于维持稳定的脑氧供需平衡,且术后苏醒迅速,后者可改善脑组织氧合状况。Objective To compare the effects of target-controlled infusion（TCI）between propofol/remifentanil and sevoflurane/remifentanil during anesthesia on cerebral oxygen metabolism in patients undergoing brain tumor surgery,so as to provide references for clinical practice.Methods A double-blind randomized,controlled trial was conducted with sixty participants,which were equally assigned to two groups.Patients in the PR Group were induced by TCI of propofol/remifentanil combination and those in the SR Group were anesthetized with sevoflurane/remifentanil combination.Blood samples were collected at different time points to measure jugular bulb venous oxygen saturation（SjvO2）and generate arteriovenous oxygen content difference（Da-jvO2）.The hemodynamic parameters and duration of surgery or anesthesia of each participant were also monitored and recorded.Results No significant difference was found regarding to the hemodynamic parameters or duration of surgery/anesthesia between the two groups.SjvO2 was found significantly higher and Da-jvO2 was significantly lower in the SR group than those in the PR group（P0.01）.Conclusion Combined anesthesia with propofol/remifentanil vs sevoflurane/remifentanil are both safe for patients undergoing cerebral tumor operation;and sevoflurane/remifentanil seems to provide better oxygen supply and has more rapid post-operation recovery;however,sevoflurane/remifentanil can improve cerebral oxygenation.

关 键 词：异丙酚 瑞芬太尼 七氟醚 脑肿瘤 神经外科手术 脑氧代谢 

分 类 号：R614.2[医药卫生—麻醉学]