舒芬太尼复合丙泊酚对幕上高血压脑出血患者应激反应及血流动力学的影响  

Effect of sufentanil combined with propofol on stress response and hemodynamics in patients with supratentorial hypertensive intracerebral hemorrhage

作　　者：李永强[1] LI Yongqiang(Department of Anesthesiology,Luohe Central Hospital,Luohe 462000,China)

机构地区：[1]漯河市中心医院麻醉科

出　　处：《中国实用神经疾病杂志》2019年第9期967-975,共9页Chinese Journal of Practical Nervous Diseases

摘　　要：目的观察舒芬太尼复合丙泊酚对幕上高血压脑出血手术患者应激反应及血流动力学的影响。方法选取2014-08—2017-12漯河市中心医院行开颅脑内血肿清除术+去骨瓣减压术治疗的幕上高血压脑出血患者102例,以随机数字表法分为对照组(n=51)与观察组(n=51)。对照组采取芬太尼复合丙泊酚麻醉,观察组采取舒芬太尼复合丙泊酚麻醉。对比2组麻醉诱导前5 min(T0)、气管插管时(T1)、气管插管后5 min(T2)、术后拔管时(T3)的血流动力学指标(舒张压、收缩压、心率)、应激反应指标[血浆血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)及血清去甲肾上腺素(NE)]水平,并对比2组术后麻醉恢复与不良反应发生情况。结果T0时2组舒张压、收缩压、心率水平间无显著差异(P>0.05),2组T1、T2、T3时舒张压、收缩压、心率水平均较T0时降低(P<0.05),观察组T0~T4时舒张压、收缩压、心率水平波动小于对照组(P<0.05);T0时2组血浆AngⅡ、ALD及血清NE水平差异无统计学意义(P>0.05),观察组T1、T2、T3时血浆AngⅡ、ALD及血清NE水平与T0时比较差异无统计学意义(P>0.05),观察组T1、T2、T3时血浆AngⅡ、ALD及血清NE水平均低于对照组(P<0.05)。2组术后拔管时间、苏醒时间、自主呼吸恢复时间对比差异无统计学意义(P>0.05)。观察组不良反应发生率11.76%(6/51),低于对照组的27.45%(14/51)(P<0.05)。结论对行开颅脑内血肿清除术+去骨瓣减压术治疗的幕上高血压脑出血患者采取舒芬太尼复合丙泊酚麻醉可稳定术中血流动力学状况,减轻机体应激反应,减少不良反应发生,且不影响术后麻醉恢复。Objective To explore the effect of sufentanil combined with propofol on stress response and hemodynamics in patients with supratentorial hypertensive intracerebral hemorrhage.Methods From August 2014 to December 2017,102 cases of supratentorial hypertensive intracerebral hemorrhage were treated with craniotomy clearance of intracerebral hematoma and decompressive craniectomy,and they were divided into the control group(n=51)and the observation group(n=51)by random digital table method.The control group was given fentanyl combined with propofol for anesthesia,while the observation group was given sufentanil combined with propofol for anesthesia.The hemodynamic indexes(diastolic pressure,systolic pressure,heart rate)],stress response indexes[plasma angiotensinⅡ(AngⅡ),aldosterone(ALD)and serum norepinephrine(NE)]were compared between the two groups 5 min before induction of anesthesia(T0),at the time of tracheal intubation(T1),5 min after tracheal intubation(T2)and postoperative extubation(T3)].The postoperative recovery from anesthesia and adverse reactions were compared between the two groups.Results There was insignificant difference in diastolic blood pressure,systolic blood pressure and heart rate between the two groups at T0(P>0.05).The diastolic blood pressure,systolic blood pressure and heart rate of the two groups at T1,T2 and T3 were lower than those at T0(P<0.05).The fluctuation of diastolic blood pressure,systolic blood pressure and heart rate in the observation group at T0-T4 was smaller than that in the control group(P<0.05).There was insignificant difference in levels of plasma AngⅡ,ALD and serum NE between the two groups at T0(P>0.05).There was insignificant difference in levels of plasma AngⅡ,ALD and serum NE in the observation group between T0 and T1,T2 and T3(P>0.05).The levels of AngⅡ,ALD and serum NE in the observation group were lower than those in the control group at T1,T2 and T3(P<0.05).There was insignificant difference in extubation time,recovery time and recovery time of spontan

关 键 词：幕上高血压脑出血 开颅脑内血肿清除术 去骨瓣减压术 舒芬太尼 丙泊酚 血流动力学 应激反应 

分 类 号：R743.34[医药卫生—神经病学与精神病学]