靶控输注丙泊酚联合舒芬太尼或瑞芬太尼在高血压患者神经外科手术的比较研究

目的比较丙泊酚联合舒芬太尼或瑞芬太尼靶控输注维持麻醉在高血压患者神经外科手术麻醉中临床效果。方法 57例血压控制不佳高血压患者(男32例、女25例),年龄42~75岁,随机分配到3组,芬太尼组(F组n=19)、舒芬太尼组(S组n=19)和瑞芬太尼组(R组n=19)。麻醉诱导:3组均丙泊酚(CP 4μg/mL)靶控输注诱导,F组给予芬太尼(3μg/kg)、S组和R组分别给予舒芬太尼(Ce0.6 ng/mL)和瑞芬太尼(CP 6 ng/mL)靶控输注。丙泊酚靶控诱导时间1 min,患者入睡后即脑电双频谱指数(BIS)<40,顺式阿曲库铵0.2 mg/kg诱导插管。麻醉维持方式同诱导。BIS值>90拔管。分别观察麻醉前(T0)、插管即刻(T1)、插管后5 min(T2),上头架前(T3)、上头架即刻(T4)、上头架后5 min(T5),拔管前(T6)、拔管即刻(T7)、拔管后15 min(T8)患者血压心率的变化。结果瑞芬太尼和舒芬太尼对控制插管和上头架引起血压升高明显优于芬太尼组(P<0.05),瑞芬太尼组引起心率下降明显大于术前或其他2组(P<0.05)。拔管即刻瑞芬太尼组血压和心率和芬太尼组没有显著性差异,舒芬太尼组血压和心率显著低于芬太尼组和瑞芬太尼组。结论仅从围麻醉期间血压和心率波动来考虑,丙泊酚联合舒芬太尼靶控输注维持麻醉在高血压患者神经外科手术麻醉中更优。

Comparative study of Sufentanil or Remifentanil target controlled infusion(TCI) for anesthesia in neurosurgical procedure of hypertensive patients

Objective To compare the effect of Propofol combined with Sufentanil or Remifentanil administered by target controlled infusion in neurosurgery of hypertensive patients.Methods Fifty-seven hypertensive patients(32 male and 25 female) aged 42～75 years undergoing neurosurgery were randomly divided in three groups: Fentanyl group(group F,n=19),Sufentanil group(group S,n=19) and Remifentanil group(group R,n=19).Following the induction of Propofol TCI(CP4 μg/mL,1 min),group F: Fentanyl(3 μg/kg), group S and group R was respectively administered by Sufentanil TCI(Ce 0.6 ng/mL) and Remifentanil TCI(CP 4 ng/mL).Atracurium,as B is below 40,was administered and intubated 3 minutes late.The same modality was applied to maintain anesthesia.Hemodynamic data in the three groups were recorded and compared by analysis of variance.Results A statistically significant difference(P<0.05) was found in hemodynamic data among the three groups.Sufentanil and Remifentanil reacted promptly.The effect of controlled the blood pressure was sure,safe and there were less side effects.But the heart rate in group R decreased significantly.There was no difference in recovery time.Conclusion According to the fluctuating level of blood pressure and heart rate,this study suggests that anesthesia with Sufentanil combined with Propofol is advantageous over anesthesia with Remifentanil or Fentanyl combined with Propofol.