舒芬太尼与芬太尼对幕上脑肿瘤患者诱导麻醉后颅内压及脑灌注压的影响对比研究  

The effects of sufentanil versus fentanyl on intracranial pressure and cerebral perfusion pressure after anesthesia induction in patients with supratentorial brain tumors

作　　者：王跃斌[1] 孙广运[1] 

机构地区：[1]四川宜宾市第二人民医院麻醉科,宜宾644000

出　　处：《中国实用神经疾病杂志》2016年第16期8-10,共3页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨舒芬太尼与芬太尼对幕上脑肿瘤患者诱导麻醉后颅内压及脑灌注压的影响,为幕上脑肿瘤手术患者选择最为安全的麻醉诱导方法。方法选取幕上脑肿瘤患者73例,随机分为2组,A组(36例)给予舒芬太尼联合咪达唑仑、异丙酚和顺式阿曲库铵进行麻醉诱导,B组(37例)除将舒芬太尼替换为芬太尼外,其余同A组。对2组颅内压和脑灌注压进行统计。结果自插管后即刻至切皮后,2组颅内压均逐渐升高,且均明显高于诱导前;开骨瓣后2组颅内压均逐渐降低,但仍然高于诱导前,差异有统计学意义(P<0.05)。至开硬膜后,2组颅内压均恢复至诱导前水平。A组自插管后即刻至开硬膜后脑灌注压均明显低于诱导前(P<0.05);B组在插管后15min、切皮后以及开骨瓣后脑灌注压明显低于诱导前(P<0.05),其他时刻与诱导前差别不大(P>0.05)。自插管后即刻至开硬膜后,A组脑灌注压明显低于B组,2组比较差异有统计学意义(P>0.05)。结论相同剂量舒芬太尼和芬太尼对幕上脑肿瘤患者进行诱导麻醉,芬太尼对脑灌注压的影响更小,两者对颅内压的影响无明显差别。Objective To investigate the effects of sufentanil vs. fentanyl on intracranial pressure and cerebral perfusion pressure after anesthesia induction in patients with supratentorial brain tumors, in order to select prior method for anesthesia induction. Methods Seventy-three cases with supratentorial brain tumors were enrolled and randomly divided into two groups. All cases received midazolam, propofol and cis-atracurium to induce anesthesia. At the same time, group A also received sufentanil and group B also received fentanyl. Then we calculated the intraeranial pressure and cerebral perfusion pressure between two groups. Results The intracranial pressures in both two groups were gradually increased and were significantly higher than those before induction ever since cannula until skin incision, which were decreased after bone flap incision but still higher than those before induction, all these differences were statistically significant（P〈0.05）, up to putamen dissection which recovered back to the pre-induction level. The cerebral perfusion pressure at the moment of cannula until putamen dissection was lower than that before induction in group A, which was lower in fifteen minutes after cannula until bone flap incision in group B（P〈 0.05）and at other moments which was similar to that before induetion（P〉0.05）. Additionally, group A showed lower cerebral perfusion pressure relative to group B（P〈0. 05）. Conclusion At the same dose, fentanyl used for anesthesia induction has less effect on cerebral perfusion pressure compared with sufentanil in patients with anesthesia induction. And there is no differential effect on intracranial pressure.

关 键 词：舒芬太尼 芬太尼 脑肿瘤 麻醉 颅内压 脑灌注压 

分 类 号：R739.41[医药卫生—肿瘤]