不同剂量舒芬太尼联合丙泊酚对脑动脉瘤夹闭手术患者生命体征 神经功能及脑氧代谢的影响  

Effect of different doses of sufentanil combined with propofol on vital signs,neurological function,and cerebral oxygen metabolism in patients undergoing clipping surgery for cerebral aneurysms

作　　者：边兴花 许鹏 BIAN Xinghua;XU Peng(Zhangjiakou First Hospital,Zhangjiakou 075000,China)

机构地区：[1]张家口市第一医院,河北张家口075000

出　　处：《中国实用神经疾病杂志》2024年第5期583-588,共6页Chinese Journal of Practical Nervous Diseases

基　　金：河北省科技计划项目(编号:20181173)。

摘　　要：目的讨论不同剂量舒芬太尼联合丙泊酚在脑动脉瘤夹闭手术患者中的应用效果。方法采用随机数字表法将2022-01—2023-06张家口市第一医院治疗的60例脑动脉瘤夹闭手术患者随机分为对照组30例和试验组30例。2组患者均采取相同的麻醉诱导,对照组麻醉维持给予0.1μg/L舒芬太尼联合丙泊酚,试验组麻醉维持给予0.25μg/L舒芬太尼联合丙泊酚,2组术后均观察1 d,比较2组术后补救镇痛率、苏醒、拔管时间,麻醉诱导前、手术结束时、术后12 h、术后1 d的生命体征、神经功能、脑氧代谢及围手术期间的不良反应发生情况。结果试验组术后补救镇痛率10.00%,低于对照组的46.67%(P<0.05)。与麻醉诱导前比较,手术结束时至术后1 d 2组舒张压(DBP)、收缩压(SBP)、心率(HR)逐渐降低,且试验组DBP、SBP、HR低于对照组(P<0.05)。与麻醉诱导前、手术结束时比较,术后12 h、1 d 2组血清髓鞘碱性蛋白(MBP)水平升高,试验组低于对照组(P<0.05)。与麻醉诱导前比较,手术结束时2组血清神经元特异性烯醇化酶(NSE)水平升高,试验组更低(P<0.05);术后12 h、1 d2组血清NSE水平逐渐降低,试验组更低(P<0.05);与手术结束时比较,术后12 h、1 d 2组血清NSE水平逐渐降低,试验组更低(P<0.05)。与麻醉诱导前、手术结束时比较,术后12 h、1 d 2组血清胶质纤维酸性蛋白(GFAP)水平逐渐升高,试验组更低(P<0.05)。与麻醉诱导前比较,手术结束时、术后12 h、1 d 2组颈内静脉血氧含量(CjvO_(2))、血氧饱和度(SjvO_(2))升高,试验组低于对照组(P<0.05),2组脑氧摄取率(CERO_(2))降低,试验组高于对照组(P<0.05)。2组围手术期间的不良反应总发生率比较无统计学差异(P>0.05)。结论与0.1μg/L舒芬太尼比较,0.25μg/L舒芬太尼联合丙泊酚可改善脑动脉瘤夹闭手术患者生命体征、神经功能及脑氧代谢,提高镇痛效果,且未明显增加不良反应。Objective To investigate the application effect of different doses of sufentanil combined with propofol in patients undergoing clipping surgery for cerebral aneurysms.Methods Sixty patients with clipping surgery for cerebral aneurysms admitted to Zhangjiakou First Hospital from January 2022 to June 2023 were randomly divided into the control group(30 cases)and the experimental group(30 cases)according to the random number table method.Both groups received the same anesthesia induction.The control group received anesthesia maintenance of 0.1μg/L sufentanil combined with propofol,while the experimental group received anesthesia maintenance of 0.25μg/L sufentanil combined with propofol.Both groups were observed for 1 day after surgery.The postoperative relief analgesia rate,times of recovery,extubation,vital signs,neurological function,cerebral oxygen metabolism before anesthesia induction,at the end of surgery,12 hours after surgery,1 day after surgery and adverse reactions during the perioperative period between the two groups were compared.Results The postoperative relief analgesia rate in the experimental group was 10.00%,which was lower than 46.67%in the control group(P<0.05).Compared with before anesthesia induction,the diastolic blood pressure(DBP),systolic blood pressure(SBP),and heart rate(HR)of the two groups gradually decreased from the end of surgery to 1 day after surgery,the experimental was lower than control group(P<0.05).Compared with before anesthesia induction and at the end of surgery,the level of serum myelin basic protein(MBP)increased in both groups at12 hours and 1 day after surgery,the experimental group was lower than the control group(P<0.05).Compared with before anesthesia induction,at the end of surgery,the level of serum neuron specific enolase(NSE)in both groups increased,experimental group was lower(P<0.05);at 12 hours and 1 day after surgery,the level of serum NSE in both decreased,experimental was lower(P<0.05);compared with the end of surgery,the level of serum NSE of the two gro

关 键 词：脑动脉瘤夹闭手术 舒芬太尼 丙泊酚 生命体征 神经功能 脑氧代谢 

分 类 号：R651.11[医药卫生—外科学]