七氟烷复合瑞芬太尼在缺血性脑卒中患者介入取栓术中的应用及对神经功能、认知功能的影响  

Application of sevoflurane combined with remifentanil in interventional thrombectomy of ischemic stroke patients and its influence on neurological and cognitive function

作　　者：程财清 冬飓 杨迎春 Cheng Caiqing;Dong Ju;Yang Yingchun(Department of Anesthesiology,Xining Third People′s Hospital,Xining 810017,China)

机构地区：[1]西宁第三人民医院麻醉科,西宁810017

出　　处：《中国医师进修杂志》2025年第2期177-181,共5页Chinese Journal of Postgraduates of Medicine

基　　金：西宁市第三人民医院2019年自选课题立项(2019-SSZTYJ-01)。

摘　　要：目的探讨七氟烷复合瑞芬太尼在缺血性脑卒中患者介入取栓术中的应用价值。方法回顾性选取2020年9月至2022年9月在西宁第三人民医院诊治的84例缺血性脑卒中患者为研究对象,均行介入取栓术,其中42例采用丙泊酚复合瑞芬太尼麻醉(常规组),42例采用七氟烷复合瑞芬太尼麻醉(试验组)。比较两组麻醉优良率,比较两组麻醉诱导前(T_(1))、手术开始时(T_(2))、取栓拔管后(T_(3))、手术结束时(T_(4))的血流动力学指标,比较两组术前和术后12、24、48 h脑损伤指标,比较两组手术前后美国国立卫生研究院卒中量表(NIHSS)评分、简易精神状态检查量表(MMSE)评分、术后认知功能障碍(POCD)及麻醉相关不良反应发生情况。结果试验组麻醉优良率高于常规组[100.00%(42/42)比83.33%(35/42)],差异有统计学意义(χ^(2)=5.61,P<0.05)。两组T_(2)、T_(3)、T_(4)时平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_(2))均较本组T_(1)时升高(P<0.05);试验组T_(2)、T_(3)、T_(4)时MAP、HR、SpO_(2)低于常规组(P<0.05)。两组术后12、24 h血清神经元特异性烯醇化酶(NSE)、S100β蛋白较术前明显升高(P<0.05);试验组术后12、24、48 h血清NSE、S100β蛋白低于常规组[(30.12±4.26)μg/L比(35.64±5.70)μg/L、(22.69±4.01)μg/L比(26.81±5.53)μg/L、(18.71±2.92)μg/L比(21.34±4.02)μg/L,(1.19±0.20)μg/L比(1.37±0.24)μg/L、(0.96±0.13)μg/L比(1.13±0.16)μg/L、(0.80±0.11)μg/L比(0.94±0.15)μg/L](P<0.05)。两组术后12、24 h NIHSS评分较术前明显升高,MMSE评分较术前明显降低(P<0.05);两组术后48 h NIHSS评分、MMSE评分恢复至术前水平(P>0.05);试验组术后12、24 h NIHSS评分低于常规组,MMSE评分高于常规组(P<0.05)。试验组麻醉相关不良反应发生率低于对照组[4.76%(2/42)比21.43%(9/42)],POCD发生率低于常规组[19.05%(8/42)比2.38%(1/42)],差异有统计学意义(χ^(2)=5.13、4.48,P<0.05)。结论七氟烷复合瑞芬太尼在缺血性脑�Objective To investigate the application value of sevoflurane combined with remifentanil in interventional thrombectomy of ischemic stroke patients and its influence on neurological and cognitive function.Methods The clinical data of 84 patients with ischemic stroke treatment in the Xining Third People′s Hospital from September 2020 to September 2022 were selected retrospectively,and they were divided into the conventional group(42 cases)and experimental group(42 cases)according the treatment methods.Interventional thrombectomy was performed in both groups.Propofol combined with remifentanil was used in the conventional group,and sevoflurane combined with remifentanil was used in the experimental group.The excellent and good rate of anesthesia was compared between the two groups;the hemodynamic indexes before anesthesia induction(T_(1)),at the beginning of surgery(T_(2)),after thrombectomy and extubation(T_(3))and at the end of surgery(T_(4))were compared between the two groups;the brain injury indexes were compared before and 12,24 and 48 h after surgery were compared between the two groups;the National Institutes of Health Stroke Scale(NIHSS)score,Simple Mental State Examination Scale(MMSE)score,postoperative cognitive dysfunction(POCD)and anesthesiation-related adverse reactions were compared between the two groups.Results The excellent and good rate of anesthesia in the experimental group was higher than that in the conventional group:100.00%(42/42)vs.83.33%(35/42),there was statistical difference(χ^(2)=5.61,P<0.05).The mean arterial pressure(MAP),heart rate(HR),and pulse oxygen saturation(SpO_(2))in the two groups at T_(2),T_(3)and T_(4)were higher than those at T_(1)(P<0.05);the MAP,HR and SpO_(2)in the experimental group at T_(2),T_(3)and T_(4)were lower than those in the conventional group(P<0.05).The serum neuron-specific enolase(NSE)and S100βprotein were significantly increased at 12 and 24 h after surgery in both groups(P<0.05);serum NSE and S100βproteins in the experimental group at 12,24 and 48

关 键 词：脑梗死 麻醉 静脉 瑞芬太尼 七氟烷 介入取栓术 

分 类 号：R61[医药卫生—外科学]