七氟醚联合瑞芬太尼维持麻醉对颅内动脉瘤介入栓塞术患者苏醒质量认知和神经损伤的影响  

Influence of sevoflurane combined with remifentanil maintenance anesthesia on recovery quality,cognitive and nerve injury in patients with interventional embolization of intracranial aneurysms

作　　者：孙亚玲 严金燕 邱海燕 SUN Yaling;YAN Jinyan;QIU Haiyan(Yancheng Clinical College of Xuzhou Medical University/Yancheng NO.1 Peoples Hospital,Yancheng 224006,China)

机构地区：[1]徐州医科大学盐城临床学院,盐城市第一人民医院,江苏盐城224006

出　　处：《中国实用神经疾病杂志》2025年第1期68-72,共5页Chinese Journal of Practical Nervous Diseases

基　　金：2020年度江苏省中医药科技发展计划项目(编号:YB2020079)。

摘　　要：目的观察七氟醚联合瑞芬太尼维持麻醉对颅内动脉瘤介入栓塞术患者苏醒质量、认知功能和神经损伤标志物的影响。方法回顾性分析盐城市第一人民医院2020-08—2023-08治疗的104例颅内动脉瘤介入栓塞术患者的临床资料,按麻醉方式不同分为常规组(n=52)和七氟醚联合组(n=52)。常规组采用常规麻醉方法,七氟醚联合组采用七氟醚联合瑞芬太尼维持麻醉方法。比较2组麻醉效果,对比2组患者苏醒质量(苏醒时间、麻醉Steward苏醒评分、术后谵妄发生率)、认知功能[记忆与执行筛查量表(MES)]和神经损伤标志物[超敏C反应蛋白(hs-CRP)、神经元特异性烯醇化酶(NSE)、髓碱性蛋白(MBP)]。结果切皮时、栓塞物置入时、术毕前10 min,2组患者平均动脉压(MAP)、心率(HR)较麻醉前均降低(P<0.05),同一时段2组间比较差异无统计学意义(P>0.05)。七氟醚联合组术后苏醒时间、术后谵妄发生率均低于常规组(P<0.05),麻醉Steward苏醒评分高于常规组(P<0.05)。苏醒时,七氟醚联合组MES评分明显高于常规组(P<0.05),苏醒1 h、6 h、12 h时2组MES评分比较差异无统计学意义(P>0.05)。术后1 d,七氟醚联合组血清hs-CRP、NSE、MBP水平均低于常规组(P<0.05)。结论七氟醚联合瑞芬太尼维持麻醉对颅内动脉瘤介入栓塞术患者的麻醉效果较好,能有效改善患者苏醒质量,减轻麻醉药物对认知功能和神经损伤的影响。Objective To observe the influence of maintenance anesthesia with sevoflurane combined with remifentanil on the recovery quality,cognitive function and nerve injury markers in patients undergoing interventional embolization of intracranial aneurysms.Methods The clinical data of 104 patients with interventional embolization of intracranial aneurysms in Yancheng NO.1 People’s Hospital were retrospectively analyzed from August 2020 to August 2023.According to the different anesthesia methods,they were classified into conventional group(n=52)and sevoflurane combination group(n=52).The conventional group applied conventional anesthesia method,while the sevoflurane combination group applied sevoflurane combined with remifentanil to maintain anesthesia.The anesthesia effect,recovery quality(recovery time,anesthesia Steward recovery score,incidence rate of postoperative delirium),cognitive function(memory and execution scale(MES))and nerve injury markers(hypersensitive C-reactive protein(hs-CRP),neuron-specific enolase(NSE),myelin basic protein(MBP))were compared between the two groups.Results The MAP and HR in both groups at the time of skin incision,the time of embolus placement and 10-minute before the end of surgery reduced compared with those before anesthesia(P<0.05),but there were no statistical differences between the two groups at the same time point(P>0.05).The postoperative recovery time and incidence rate of post-operative delirium were shorter or lower in the sevoflurane combination group than those in the conventional group(P<0.05),while the anesthesia Steward recovery score was higher than that in the conventional group(P>0.05).At recovery,the MES score in the sevoflurane combination group was significantly higher compared with that in the conventional group(P<0.05).There was no statistical significance on MES score between the two groups at 1-hour,6-hour and 12-hour of recovery(P>0.05).At 1-day after surgery,the levels of serum hs-CRP,NSE and MBP in the sevoflurane combination group were lower compared

关 键 词：颅内动脉瘤 介入栓塞术 七氟醚 瑞芬太尼 苏醒质量 认知功能 神经损伤标志物 

分 类 号：R651.11[医药卫生—外科学]