右美托咪定复合瑞芬太尼与七氟烷复合瑞芬太尼麻醉方案在老年脑缺血手术中的应用效果对比  

Comparison of the application effect of dexmedetomidine combined with remifentanil and sevoflurane combined with remifentanil anesthesia in elderly cerebral ischemia surgery

作　　者：李慧 师爱青 张健星 Li Hui;Shi Aiqing;Zhang Jianxing(Department of Anesthesia,Central Hospital of Jiaozuo Coal(Group)Co.,Ltd.,Jiaozuo 454150,China)

机构地区：[1]焦作煤业(集团)有限责任公司中央医院麻醉科,焦作454150

出　　处：《中国实用医刊》2025年第2期43-46,共4页Chinese Journal of Practical Medicine

摘　　要：目的对比分析右美托咪定复合瑞芬太尼与七氟烷复合瑞芬太尼麻醉方案在老年脑缺血手术中的应用效果。方法队列研究。抽取2022年12月至2023年12月于焦作煤业(集团)有限责任公司中央医院行手术治疗的老年脑缺血患者96例,按随机数字表法分为A组与B组,每组48例。两组均选择丙泊酚、舒芬太尼及罗库溴铵诱导麻醉,A组通过吸入七氟烷维持镇静+瑞芬太尼镇痛,B组通过滴注右美托咪定维持镇静+瑞芬太尼镇痛。比较两组血流动力学指标、苏醒质量、氧化应激指标[白细胞介素-6(IL-6)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)]与不良反应发生率。结果气管插管后、手术结束前,两组平均动脉压与心率均高于麻醉诱导前,且A组高于B组(P<0.05)。拔管后,B组躁动评分低于A组(P<0.05)。术后,两组血清IL-6、MDA水平高于术前,GSH-Px水平低于术前(P<0.05);且B组MDA水平低于A组,GSH-Px水平高于A组(P<0.05)。两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论在老年脑缺血手术患者麻醉中,七氟烷复合瑞芬太尼、右美托咪定复合瑞芬太尼均安全有效,右美托咪定在稳定血流动力学、减少术后躁动、减轻氧化应激等方面更具优势。Objective To compare and analyze the application effect of dexmedetomidine combined with remifentanil and sevoflurane combined with remifentanil anesthesia in elderly cerebral ischemia surgery.Methods A total of 96 elderly patients with cerebral ischemia who underwent surgery in Central Hospital of Jiaozuo Coal(Group)Co.,Ltd.from December 2022 to December 2023 were selected for the cohort study,and they were divided into the group A and the group B according to the random number table method,with 48 cases in each group.Propofol,sufentanil and rocuronium were used to induce anesthesia in both groups.Group A maintained sedation by inhalation of sevoflurane+remifentanil analgesia,and group B maintained sedation by infusion of dexmedetomidine+remifentanil analgesia.The hemodynamic indexes,recovery quality,oxidative stress indexes including interleukin-6(IL-6),malondialdehyde(MDA),and glutathione peroxidase(GSH-Px),and incidence of adverse reactions were compared between the two groups.ResultsAfter tracheal intubation and before the end of operation,the mean arterial pressure and heart rate of the two groups were higher than those before anesthesia induction,and the above indexes in group A were higher compared with group B(P<0.05).After extubation,the agitation score in group B was lower than that in group A(P<0.05).After operation,the levels of serum IL-6 and MDA in the two groups were higher than those before operation,and the level of GSH-Px was lower than that before operation(P<0.05);the level of MDA in group B was lower,and the level of GSH-Px was higher compared with group A(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions In the anesthesia of elderly patients undergoing cerebral ischemia surgery,sevoflurane combined with remifentanil and dexmedetomidine combined with remifentanil are safe and effective.Dexmedetomidine has more advantages in stabilizing hemodynamics,reducing postoperative agitation and oxidative stress.

关 键 词：脑缺血 手术 麻醉 右美托咪定 七氟烷 瑞芬太尼 

分 类 号：R61[医药卫生—外科学]