七氟烷与丙泊酚用于动脉瘤夹闭手术患者控制性降压的临床研究  

The comparison of sevoflurane and propofol in controlled hypotension of craniotomy for intracranial aneurysm

作　　者：翟振平[1] 张俊杰[1] 鄢建勤[1] 

机构地区：[1]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《现代医学》2015年第7期813-818,共6页Modern Medical Journal

基　　金：湖南省自然科学基金资助项目(12jj5051)

摘　　要：目的:观察并比较七氟烷与丙泊酚用于颅内动脉瘤夹闭手术患者进行控制性降压的效果。方法:选择择期行开颅动脉瘤夹闭手术的患者38例,随机分为S、P两组(n=19),S组以七氟烷为主,P组以丙泊酚为主,复合镇痛及肌肉松弛药物进行全身麻醉,必要时联合硝酸甘油进行控制性降压。评估和比较两组患者的手术情况、血流动力学参数、血浆神经元特异性烯醇化酶(NSE)的浓度和神经功能评分(短期辅导记忆浓缩试验,SOMCT)变化。结果:两组患者的麻醉均能满足动脉瘤夹闭手术要求,同时S组患者在夹闭动脉瘤时收缩压及平均动脉压比P组患者低,达到控制性降压目的所需硝酸甘油量控制血压者比P组少,差异有统计学意义(P<0.05)。两组患者术前、术毕及术后两天血浆NSE含量,术前和术后两天的SOMCT评分及差值,术后住院天数的差异无统计学意义。结论:开颅夹闭颅内动脉瘤手术中,七氟烷麻醉能够提供和丙泊酚相似的确切有效的控制性降压效果,同时对患者术后短期神志功能恢复及血浆中NSE浓度的影响与丙泊酚相近。Objective： To observe and compare the general anesthetics by sevoflurane and propofol in patients undergoing craniotomy for clamping intracranial aneurysm. Methods： Thirty-eight patients scheduled for intracranial aneurysm clamping,were randomly allocated into 2 groups（ 19 patients each）,sevoflurane group（ Group S） and propofol（ Group P） group. According to the allocated group,patients in proup S received inhalation anesthesia compound intravenous anesthesia,the others used intravenous anesthesia. Hypotension was controlled by using sevoflurane or propofol,combined with nitroglycerin when it was necessary. Assessed the hemodynamic parameters,score of short orientation memory concentration test（ SOMCT）,and concentration of NSE in the plasma. Results：Systolic and mean arterial pressures were significantly lower in sevoflurane group than the propofol group at the time of aneurysm clipping（ P〈0. 05）. The use of nitroglycerin was less in sevoflurane group than propofol group for controlled hypotension（ P〈0. 05）. No statistically significant changes in the 2 groups regarding intraoperative brain swelling,the length of postoperative hospital days,the score of SOMCT,and concentration of NSE in the plasma（ P〈0. 05）. Conclusion： Sevoflurane and propofol can be used for control blood pressure in intracranial aneurysm clamping operations in some cases. Anesthesia by sevoflurane can offer more satisfactory effects than propofol on hemodynamic parameters in intracranial aneurysm clamping operations.

关 键 词：七氟烷 丙泊酚 动脉瘤 脑保护 神经元特异性烯醇化酶 短期辅导记忆浓缩试验评分 

分 类 号：R651.1[医药卫生—外科学] R614.2[医药卫生—临床医学]