不同剂量丙泊酚静脉麻醉对急性重型颅脑损伤患者术后神经功能的影响

目的：探讨不同剂量丙泊酚静脉麻醉对急性重型颅脑损伤患者术后神经功能的影响。方法选取接诊的急性重型颅脑损伤患者80例,随机分为观察组和对照组,每组40例。2组患者均使用丙泊酚进行静脉麻醉,观察组输注剂量为4 mg·kg-1·h-1,对照组剂量为8 mg·kg-1·h-1,观察2组患者在麻醉诱导前(T1)、气管插管后(T2)、硬脑膜切开后(T3)、输注2 h后(T4)、手术结束时(T5)时间点颅内压、脑氧分压的变化以及在T1和T5时白介素1(IL-1)、白介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、β蛋白(S100β)的变化,记录术后不良神经功能情况。结果T5时间点,观察组颅内压水平低于对照组,脑氧分压水平高于对照组,差异有统计学意义( P <0.05)；在T5时间点,观察组IL-1、IL-6、TNF-α、S100β蛋白均低于对照组( P <0.05)；手术后,观察组不良神经功能总发生率为5.00%低于对照组的25.00%,差异有统计学意义( P <0.05)。结论在急性重型颅脑损伤患者的静脉麻醉中不宜使用8 mg·kg-1·h-1剂量的丙泊酚,会对患者的神经功能造成损伤,对此类患者应选择4 mg·kg-1·h-1剂量丙泊酚,以提高脑组织功能的恢复。

Effects of different dose of propofol by intravenous anesthesia on neurological function of patients with acute severe craniocerebral injury after operation

Objective To investigate the effects of different dose of propofol by intravenous anesthesia on neurological function of patients with acute severe craniocerebral injury after operation. Methods Eighty patients with acute severe craniocerebral injury who were admitted and treated in our hospital were enrolled in the study. According to random digits table these patients were divided into observation group and control group, with 40 patients in each group. The patients in both groups were given propofol for intravenous anesthesia,the drug dose in observation group was 4mg·kg-1 ·h-1 ,however, the dose in control group was 8mg·kg-1 ·h-1 . The changes of intracranial pressure and cerebral oxygen partial pressure were observed before anesthesia induction (T1), after trachea cannula (T2), after cerebral dura mater incision (T3),after 2-hour infusion (T4), at end of operation (T5) in both groups. The changes of levels of interleukin 1(IL-1), interleukin 6(IL-6), tumor necrosis factor-alpha ( TNF-α) , S100β100βwere observed and compared between two groups. Besides the neurological function status of patients after operation was observed. Results The intracranial pressure at T5 in observation group was obviously lower than that in control group,however, the cerebral oxygen partial pressure (16. 72 ± 4. 29) was significantly higher than that in control group ( P <0. 05). The levels of IL-1, TNF-α, IL-6 and S100βat T5 in observation group were, respectively, which were significantly lower than those in control group,respectively ( P <0. 05). After surgery, the total incidence of adverse neurological function in observation group was 5%, which was significantly lower than that ( 25%) in control group ( P <0. 05). Conclusion It is not suitable to apply propofol in a dose of 8mg·kg-1 ·h-1 for intravenous anesthesia in patients with acute severe craniocerebral injury, which may damage neurological function of patients, thus, 4mg·kg-1 ·h-1 dose of propofol should be applied to improve the recovery of neurological function of patients.