瑞芬太尼与异丙酚、苯磺顺阿曲库铵联合应用对重症脑出血患者术后脑保护作用的影响  

Efficacy of combined use of remifentanil, propofol and atracurium cisbenzenesulfonate in postoperative brain protection in patients with severe cerebral hemorrhage

作　　者：朱绪贤 杨秋莉 刘轩 史周鼐 姜建华 Zhu Xu-xian;Yang Qiu-li;Liu Xuan;Shi Zhou-nai;Jiang Jian-hua(Department of Anesthesiology,Baoji Hospital Affiliated to Xi'an Medical College,Baoji 721006,China)

机构地区：[1]西安医学院附属宝鸡医院麻醉科,宝鸡721006

出　　处：《中国药物应用与监测》2024年第5期563-567,共5页Chinese Journal of Drug Application and Monitoring

摘　　要：目的 探讨瑞芬太尼与异丙酚、苯磺顺阿曲库铵联合应用对重症脑出血患者术后脑保护作用的影响。方法 选取2019年1月至2023年12月在西安医学院附属宝鸡医院接受治疗的120例重度脑出血患者,采用随机数字表法将患者分为观察组和对照组,每组60例。对照组接受咪唑安定+瑞芬太尼+苯磺顺阿曲库铵治疗,观察组接受瑞芬太尼+异丙酚+苯磺顺阿曲库铵治疗。比较两组血流动力学指标、血清神经元特异性烯醇化酶(NSE)、S100-β蛋白、围手术期并发症、重症监护疼痛观察量表(CPOT)评分、Richmond躁动-镇静评分系统(RASS)评分、格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分。结果 观察组术后收缩压、舒张压、心率均低于对照组,差异有统计学意义(均P<0.05);手术后,观察组患者S100-β蛋白水平、NSE水平[分别为(1.45±1.09)μg·L^(-1),(13.20±4.06)μg·L^(-1)]均低于对照组[分别为(3.22±1.32)μg·L^(-1),(16.95±3.96)μg·L^(-1)],差异有统计学意义(t=3.989,P=0.012;t=2.463,P=0.039);观察组机械通气时间、入住重症监护室时间、术后3个月再出血风险[分别为(5.76±2.21) d、(7.25±2.41) d、3(5.00%)]均低于对照组[分别为(7.33±2.84) d、(9.92±2.51) d、10(16.67%)](t=3.379,5.944,χ^(2)=4.231,均P<0.05);观察组术后的CPOT与RASS评分低于对照组,差异有统计学意义(均P<0.05);术后24 h,观察组GCS评分为(12.34±1.66)分,高于对照组的(8.21±2.80)分,差异有统计学意义(t=9.828,P<0.05);术后24 h,观察组NIHSS评分为(15.05±2.84)分,低于对照组的(19.31±1.76)分,差异有统计学意义(t=9.876,P<0.05)。结论 瑞芬太尼与异丙酚、苯磺顺阿曲库铵联用应用于重度脑出血患者中可使患者血流动力学指标维持平稳,降低血浆S100-β及NSE含量,减轻脑损伤。Objective To explore the effect of the combined application of remifentanil with propofol and cisatracurium besylate for postoperative brain protection in patients with severe cerebral hemorrhage.Methods One hundred and twenty patients with severe cerebral hemorrhage treated in Baoji Hospital Affiliated to Xi’an Medical College from January 2019 to December 2023 were selected as the subjects and divided into an observation group and a control group using a randomized numerical table,with 60 in each group.The patients in the control group received imipramine+remifentanil+cisatracurium besylate treatment while those in the observation group received remifentanil+propofol+cisatracurium besylate treatment.The hemodynamics,serum neuron-specific enolase(NSE),S100-βprotein,perioperative complications,Critical care Pain Observation Tool(CPOT),Richmond Agitation-Sedation Scale(RASS),Glasgow Coma Scale(GCS)and National Institute of Health stroke scale(NIHSS)were compared between the two groups.Results Postoperative systolic blood pressure,diastolic blood pressure and heart rate of the observation group were lower than those of the control group,and the differences were statistically significant(all P<0.05).After surgery,the S100-βprotein level of the patients in the observation group was(1.45±1.09)μg·L^(-1) and the NSE level was(13.20±4.06)μg·L^(-1),which were lower than those of(3.22±1.32)μg·L^(-1) and(16.95±3.96)μg·L^(-1),in the control(t=3.989,P=0.012,t=2.463,P=0.012).The observation group's time of mechanical ventilation,time of admission to the intensive care unit,and risk of rebleeding at 3 months postoperatively were(5.76±2.21)d,(7.25±2.41)d,and 3(5.00%),respectively,which were lower than those of the control((7.33±2.84)d,(9.92±2.51)d,10(16.67%))(t=3.379,5.944,χ^(2)=4.231,all P<0.05).Following surgery,the observation cohort exhibited reduced CPOT and RASS ratings compared to the control cohort,with these disparities being statistically considerable(all P<0.05).At 24 h postoperatively, the GCS sc

关 键 词：重症脑出血 瑞芬太尼 异丙酚 苯磺顺阿曲库铵 脑损伤 血流动力学指标 

分 类 号：R614[医药卫生—麻醉学]