开颅血肿清除术治疗高血压脑出血的麻醉处理  

Analysis of anesthesia management in craniotomy evacuation of hematoma for treating hypertensive cerebral hemorrhage

作　　者：朱敦[1] Zhu Dun(The First Affiliated Hospital of Xi ＇an Jiaotong University ,Xi＇an 710043 ,China)

机构地区：[1]西安交通大学第一附属医院,西安710043

出　　处：《中国实用神经疾病杂志》2016年第20期3-5,共3页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨开颅血肿清除术治疗高血压脑出血的麻醉处理。方法选择我院2012-03—2014-12收治的89例高血压脑出血患者为研究对象,随机数字表法分为A、B组。A组采取舒芬太尼+异丙酚全凭静脉麻醉,B组采取异氟醚+芬太尼静吸复合麻醉,比较2组不同时刻血流动力学指标、麻醉恢复情况及不良反应发生率。结果 A组麻醉后,仅T_4、T_5时刻HR与T_5时刻SBP与T_0时刻前后对比差异有统计学意义(P<0.05);B组麻醉后,T_1、T_2、T_3、T_4、T_5等时刻HR、SBP、DBP指标的T_0时刻值前后相比差异均有统计学意义(P<0.05)。同时A组T_1、T_2、T_3、T_4、T_5时刻的HR、SBP、DBP均明显低于B组,组间比较差异有统计学意义(P<0.05)。A组呼吸功能恢复时间、拔管时间、吞咽反射时间均短于B组,差异有统计学意义(P<0.05)。A组躁动、呛咳发生率分别为8.9%、6.7%,均低于B组,差异有统计学意义(P<0.05)。结论开颅血肿清除术治疗高血压脑出血可采用舒芬太尼复合异丙酚全凭静脉麻醉,减轻对血流动力学的影响并减少躁动、呛咳等不良反应,安全性高,值得借鉴。Objective To explore anesthesia management of craniotomy evacuation of hematoma for treating hypertensive cerebral hemorrhage.Methods Totally 89 cases with hypertensive cerebral hemorrhage admitted into the hospital from March 2012 to December 2014 were selected as the research subjects and were randomly divided into two groups.Group A received total intravenous anesthesia with sufentanil and propofol,while group B received inhalational combined anesthesia with isoflurane and fentanyl.The hemodynamic indexes at different time,anesthesia recovery and the incidence rate of adverse reactions between the two groups were compared.Results After anesthesia in group A,the HR only at T4 and T5 and SBP at T5 showed statistically significant differences compared with those at T0（P〈0.05）.After anesthesia in group B,HR,SBP and DBP at T1,T2,T3,T4 and T5 presented statistically significant differences compared with those at T0（P〈0.05）,and all of which were obviously lower in the group A than those in group B（P〈0.05）.The recovery time of respiratory function,extubation time and swallowing reflex time in group A were shorter than those in group B and all differences were statistically significant（P〈0.05）.The incidence rates of restlessness and cough in group A were 8.9% and 6.7%,significantly lower than those in group B（P〈0.05）.Conclusion The total intravenous anesthesia with sufentanil and propofol can be applied to craniotomy evacuation of hematoma for treating hypertensive cerebral hemorrhage,which can reduce the influence on hemodynamic stability and reduce incidence rates of agitation,cough and other adverse reactions with high safety.

关 键 词：开颅血肿清除术 高血压脑出血 血流动力学 麻醉 

分 类 号：R743.34[医药卫生—神经病学与精神病学]