舒芬太尼联合瑞芬太尼对急诊颅脑外伤手术患者的应激状况及血流动力学的影响  

Effects of sufentanil combined with remifentanil on stress status and hemodynamics in patients undergoing emergency craniocerebral trauma surgery

作　　者：张久祥[1] 李世多 白延成 王小慧[1] 李慧[1] ZHANG Jiu-xiang;LI Shi-duo;BAI Yan-cheng;WANG Xiao-hui;LI Hui(Department of Anesthesia and Perioperative Medicine,Xijing Hospital of Fourth Military Medical University,Xi'an 710038,Shaanxi,CHINA;Department of Anesthesiology,Yan'an People's Hospital,Yan'an 716000,Shaanxi,CHINA)

机构地区：[1]第四军医大学西京医院麻醉与围术期医学科,陕西西安710038 [2]延安市人民医院麻醉科,陕西延安716000

出　　处：《海南医学》2020年第24期3191-3194,共4页Hainan Medical Journal

摘　　要：目的探讨舒芬太尼联合瑞芬太尼对急诊颅脑外伤手术患者应激状况及血流动力学的影响。方法选择2018年2月至2020年2月第四军医大学西京医院急诊科收治的82例颅脑外伤患者作为研究对象。采用简单随机数表法分为观察组和对照组各41例。对照组给予瑞芬太尼麻醉,观察组给予瑞芬太尼联合舒芬太尼麻醉。比较两组患者的麻醉效果,麻醉诱导前(T0)、气管插管前(T1)、气管插管后1 min(T2)、拔管时(T3)时的心率(HR)、平均动脉压(MAP)、去甲肾上腺素(NE)和血管紧张素Ⅱ(AngⅡ)水平,以及不良反应发生情况。结果观察组患者的自主呼吸恢复时间、意识清醒时间、气管拔管时间分别为(3.52±0.47)min、(6.79±1.20)min、(3.79±0.51)min,明显短于对照组的(5.87±0.56)min、(9.79±1.02)min、(5.99±0.61)min,而麻醉维持时间为(87.13±5.12)min,明显长于对照组的(74.13±4.39)min,差异均有统计学意义(P<0.05);观察组患者T1时的HR为(77.12±4.13)次/min,明显高于T0时的(71.02±5.12)次/min,差异有统计学意义(P<0.05);T1、T2、T3时,观察组患者的HR为(77.12±4.13)次/min、(70.46±3.56)次/min、(71.13±4.09)次/min,明显低于对照组的(90.71±4.18)次/min、(77.13±4.03)次/min、(79.85±3.79)次/min,差异均有统计学意义(P<0.05);T2时,观察组患者的MAP为(98.30±2.10)mmHg,明显低于对照组的(100.16±4.79)mmHg,而T1、T3时观察组患者的MAP分别为(97.13±4.62)mmHg、(97.98±4.01)mmHg,明显高于对照组的(88.13±3.10)mmHg、(94.13±3.02)mmHg,差异均有统计学意义(P<0.05);两组患者在T1、T2、T3时的NE、AngⅡ明显高于T0时,但观察组患者在T1、T2、T3时的NE分别为(317.25±14.79)mg/L、(331.79±14.77)mg/L、(340.13±13.97)mg/L,AngⅡ分别为(35.12±3.02)μg/L、(35.02±2.42)μg/L、(36.13±2.71)μg/L,明显低于同时间对照组[NE:(324.23±13.20)mg/L、(352.13±14.13)mg/L、(356.25±15.13)mg/L;AngⅡ:(37.13±3.11)μg/L、(37.98±2.79)μg/L、(40.13±3.02)μg/L],差异�Objective To explore the effect of sufentanil combined with remifentanil on the stress status and hemodynamics of patients undergoing emergency craniocerebral trauma surgery,so as to provide a basis for the diagnosis and treatment of patients.Methods Eighty-two patients with craniocerebral trauma admitted to the Emergency Department,Xijing Hospital of Fourth Military Medical University from February 2018 to February 2020 were selected as the research objects.Using simple random number table,the patients were divided into an observation group and a control group,with 41 patients in each group.The control group was given anesthesia with remifentanil,and the observation group was given anesthesia with remifentanil combined with sufentanil.The anesthesia effects of the two groups,the heart rate(HR),mean arterial pressure(MAP),the levels of norepinephrine(NE)and angiotensinⅡ(AngⅡ)before induction of anesthesia(T0),before tracheal intubation(T1),1 min after tracheal intubation(T2),and at the time of extubation(T3)were compared between the two groups,as well as the occurrence of adverse reactions.Results The recovery time of spontaneous breathing,consciousness time,tracheal extubation time were(3.52±0.47)min,(6.79±1.20)min,(3.79±0.51)min in the observation group,significantly shorter than(5.87±0.56)min,(9.79±1.02)min,(5.99±0.61)min in the control group,and the anesthesia maintenance time was(87.13±5.12)min,significantly longer than(74.13±4.39)min in the control group(P<0.05).In the observation group,HR at T1 was(77.12±4.13)times/min,significantly higher than(71.02±5.12)times/min at T0(P<0.05);at T1,T2,and T3,the HR of the observation group was(77.12±4.13)times/min,(70.46±3.56)times/min,(71.13±4.09)times/min,which was significantly lower than(90.71±4.18))times/min,(77.13±4.03)times/min,(79.85±3.79)times/min of the control group(P<0.05).At T2,the MAP of the observation group was(98.30±2.10)mmHg,which was significantly lower than(100.16±4.79)mmHg of the control group,while at T1 and T3,MAP in the obse

关 键 词：颅脑外伤 舒芬太尼 瑞芬太尼 应激反应 血流动力学 不良反应 

分 类 号：R651.15[医药卫生—外科学]