颅内手术中异丙酚联合不同阿片类药物持续静脉输注的疗效比较

目的观察异丙酚联合芬太尼、舒芬太尼、瑞芬太尼持续静脉输注在颅内手术中的应用，比较其优劣。方法颅内手术患者75例，年龄20-60岁，性别不限，ASAⅡ～Ⅲ级；随机分成芬太尼组、舒芬太尼组、瑞芬太尼组。监测术中血流动力学变化，观察患者苏醒和并发症情况，进行术后VAS疼痛及OAAS意识评分。结果芬太尼在开颅、关颅、拔管时平均动脉压（MAP）、心率（HR）均明显高于基础值（P〈0．05），舒芬太尼、瑞芬太尼在开颅、颅内手术期、关颅均低于基础值（P〈0．05）；颅内手术各期芬太尼的MAP、HR值均高于舒芬太尼、瑞芬太尼组（P〈0．05），而在开颅、颅内手术期瑞芬太尼要明显低于舒芬太尼组（P〈0．05）；三组患者针刺疼痛时间舒芬太尼最长11．7±1．6（P〈0、05），瑞芬太尼最短6．0±1．2（P〈0．05）；在拔管5minOAAS评分芬太尼组最低，为2．0±0．3（P〈0．05），而舒芬太尼、瑞芬太尼组间差异无统计学意义（P〉0．05）；但术后1h、2h、4h舒芬太尼组VAS疼痛评分明显低于芬太尼、瑞芬太尼组（P〈0．05），12h达到高峰，8h后差异无统计学意义（P〉0．05）；术后恶心呕吐（PONV）发生率芬太尼组明显高于舒芬太尼、瑞芬太尼组（P〈0．05）。结论瑞芬太尼联合异丙酚持续静脉输注用于颅内手术优于芬太尼或舒芬太尼，而舒芬太尼优于芬太尼。

Comparison of different kinds of opioids with propofol through continuous intravenous infusion in intracranial surgery

Objective To compare the application of propofol combining with fentanyl, sufentanil, and remifentanil in intracranial surgery. Method 75 patients were randomly divided into three groups＂ fentanyl group, sufentanil group, remifentanil group. Blood flow indicators during operation, waking and complications were monitored. VAS and OAAS grades were evaluated. Results Mean artery pressure（MAP）, heart rate（HR） in fentanyl group during opening or closing skull or extubation were significantly higher than basic evaluations（ P 〈 0.05）, but sufentanil group and remifentanil group were lower than basic evaluations during opening or closing skull and intracranial period （ P 〈 0.05） ; MAP and HR of fentanyl group in every intracranial episodes were higher than sufenanil group and remifentanil group （ P 〈 0.05）, but remifentanil group was significantly lower than sufentanil group during opening skull or intracranial period（ P 〈 0.05）; pinprick reaction emergence time of sufentanil group was longest（11.7 ± 1.6, P 〈 0.05 ）, remifentanil group was shortest （6.0 ± 1.2, P 〈 0.05） ; 5 minutes after extubation, OAAS grades of fentanyl group were lowest （ 2.0 ± 0.3）. There was no variance between sufentanil group and remifentanil group （ P 〉 0.05） ; VAS grades of sufentanil group at 1 h, 2 h, 4 h points after operations was significantly lower than fentanyl group and remifentanil group （ P 〈 0.05）. 12 h point was the peak, no statistic variance after 8 h ;PONV rate of fentanyl group was significantly higher than sufentanil group and remifentanil group （ P 〈 0.05）. Conclusions Remifentanil combining with propofol through continuous intravenous infusion is superior to fentanyl or sufentanil in intracranial surgery. Sufentanil is superior to fentanyl.