舒芬太尼与芬太尼用于神经外科手术麻醉的临床比较

目的：比较舒芬太尼与芬太尼复合七氟烷麻醉在神经外科手术中对血流动力学、拔管时间、苏醒时间及术后疼痛情况的影响。方法：择期开颅手术患者60例,随机分为舒芬太尼（S）组和芬太尼（F）组,每组30例。将S和F的效能比定为10：1,复合咪唑安定、维库溴胺、异丙酚来进行麻醉诱导;麻醉维持均复合七氟烷。分别记录麻醉前、诱导后、插管时和拔管时血压和心率变化;呼吸恢复、睁眼和拔管时间以及拔管后半小时疼痛评分（VAS评分）。结果：两组麻醉诱导后收缩压（SBP）、舒张压（DBP）、心率（HR）均较诱导前有显著性下降（P〈0.05）。F组插管及拔管时,血流动力学变化均较S组有显著性升高（P〈0.05）。S组苏醒期呼吸恢复、睁眼、拔管时间较F组明显缩短;拔管后半小时疼痛评分（VAS评分）S组低于F组。结论：与芬太尼相比,等效剂量的舒芬太尼用于脑外科手术患者麻醉诱导可更有效地减轻全麻诱导气管插管时的心血管反应;在麻醉苏醒期,更有利于呼吸管理及术后镇痛。舒芬太尼在神经外科麻醉中具有很好的临床应用价值。

Comparison between Sufentanil and Fentanylon Their Clinical Effect in Neurosury

Objective：To compare the effects of sufentanil or fentanyl combined with sevoflurane on the hemodynamics,time of extubation,time of emergence and postoperative pain during the elective neurosurgery.Methods：Sixty ASAⅠorⅡpatients scheduled for neurosurgery were randomly divided into two groups：group sufentanil（S,n=30） and group fentanyl（F,n=30）.Compared to decides as 10：l S and the F potency.The patients in group S were given sufentanil,and the patients in group F were given midazolam,vecuronium and propofol and fentanil for induction. Both groups used sevoflurane for maintenance. Not only the blood pressure and heart rate before and after induction, intubation and extubation, but also the time of respiratory recovery, open eyes and extubation and the score of pain after half an hour of extubation （visual analog scale, VAS） were recorded. Results.. Systolic pressure （SBP）, diastolic pressure （DBP）,and the heart rate （HR） after induction were lower in both two groups（P〈0.05）, but they showed no difference between two groups （p 〈0. 05）. Compared with S group, the hemodynamics of group F showed significant changes during intubation and extubation （P〈0.05）. And time of respiratory recovery, open eyes and extubating in S group were shorter than group F. Pain after half an hour of Extubation （VAS） in S group was lower than group F. Conclusion： For neurosurgery, the equivalent dosage of sufentanil with sevoflurane could effectively reduce the cardiovascular response during the induction of general anesthesia. And it had more advantages for the respiratory management and postoperative analgesia. Sufentanil may he more suitable for neurosurgery anesthesia.