七氟烷或丙泊酚在颅脑术中的应用及术后转归相关因素分析  

Application of Sevoflurane or Propofol in Craniocerebral Surgery and Analysis of Related Factors for Postoperative Outcome

作　　者：樊勇 廖兴志[1] 刘宇芳[1] 陆海波 肖骥峰 FAN Yong;LIAO Xingzhi;LIU Yufang(Anesthesia Department of the 904th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Jiangsu Wuxi 214000,China)

机构地区：[1]中国人民解放军联勤保障部队第904医院麻醉科,江苏无锡214000

出　　处：《河北医学》2024年第4期692-697,共6页Hebei Medicine

基　　金：江苏省无锡市科技局项目(编号:Y2021046)。

摘　　要：目的:探究七氟烷或丙泊酚在颅脑术中的应用,分析颅脑术后患者转归相关影响因素。方法:选2020年3月至2022年3月于我院行颅脑手术的患者144例为研究对象,依据双色球法将其分为七氟烷组、丙泊酚组,每组72例。七氟烷组接受七氟烷吸入麻醉,丙泊酚组采用丙泊酚静脉麻醉。比较两组血清C反应蛋白(CRP)、白细胞介素(IL)-6、神经元特异性烯醇化酶(NSE)水平、急性生理与慢性健康(APACHRE)Ⅱ评分以及格拉斯哥昏迷评分(GCS)差异。根据GCS评分将患者分为转归不良组(GCS≤11分,21例)、转归良好组(GCS>11分,123例),采用logistic回归分析影响患者术后转归的因素。结果:七氟烷组、丙泊酚组患者术前、术后1d CRP、IL-6、NSE水平及差值比较差异无统计学意义(P>0.05)。七氟烷组、丙泊酚组术前、术后3d APACHEⅡ、GCS评分及差值比较差异无统计学意义(P>0.05)。与转归良好组相比,转归不良组年龄更高,手术时间更长,入院GCS评分更低,入院瞳孔散大、低血压、合并消化道出血、合并肺部感染占比更多(P<0.05)。logistic回归分析显示年龄、手术时间、入院GCS评分是颅脑手术患者术后转归不良的影响因素(P<0.05)。结论:与丙泊酚相比,七氟烷在颅脑术中实施维持麻醉对患者术后转归不良无明显影响,年龄、手术时间、入院GCS评分是颅脑手术患者术后转归不良的影响因素。Objective:To explore the application of sevoflurane or propofol in craniocerebral surgery,and analyze the relevant factors affecting the prognosis of patients after craniocerebral surgery.Methods:A to-tal of 144 patients undergoing craniocerebral surgery in our hospital from March 2020 to March 2022 were se-lected as the study subjects.They were divided into sevoflurane group and propofol group according to the ran-domized double-blind method,with 72 patients in each group.The sevoflurane group received sevoflurane in-halation anesthesia,while the propofol group received propofol intravenous anesthesia.The serum levels of C-reactive protein(CRP),interleukin-6(IL-6),neuron specific enolase(NSE),acute physiological and chronic health(APACHRE)II scores,and Glasgow coma score(GCS)were compared between the two groups.According to the GCS score,the patients were divided into a poor outcome group(GCS≤11 points,21 cases)and a good outcome group(GCS>11 points,123 cases).Logistic regression analysis was used to analyze the factors affecting the postoperative outcome of the patients.Results:There was no significant differ-ence in CRP,IL-6 and NSE levels and differences between sevoflurane group and propofol group before and 1 day after surgery(P>0.05).There was no significant difference in 3d APACHEⅡand GCS scores and differences between sevoflurane group and propofol group before and after surgery(P>0.05).Compared with the group with good outcome,the group with poor outcome had a higher age,longer surgical time,lower ad-mission GCS scores,and a higher proportion of admission pupil dilation,hypotension,gastrointestinal bleed-ing,and pulmonary infection(P<0.05).Logistic regression analysis showed that age,surgical time,and ad-mission GCS score were the influencing factors for poor postoperative outcome in patients undergoing cranioce-rebral surgery(P<0.05).Conclusion:Compared with propofol,maintenance anesthesia with sevoflurane during craniocerebral surgery has no significant impact on poor postoperative outcome.Age,sur

关 键 词：七氟烷 丙泊酚 颅脑术 转归 麻醉 影响因素 

分 类 号：R614[医药卫生—麻醉学]