神经外科手术病人丙泊酚靶控输注复合舒芬太尼和芬太尼麻醉的效果比较

目的评价神经外科手术病人丙泊酚靶控输注复合舒芬太尼或芬太尼麻醉的效果。方法择期神经外科手术病人40例，ASAI级或II级，随机分为两组：丙泊酚-舒芬太尼组（S组）和丙泊酚-芬太尼组（F组），每组20例。术中S组持续输注舒芬太尼0．02～0．05μg／（kg·min），F组单次静脉注射芬太尼，每次1～2μg／kg。分别于麻醉诱导前（T0，基础值）、气管插管前即刻（T1）、气管插管后即刻（T2）、上头架后即刻（T3）、切皮后即刻（T4）、颅内占位切除约一半时（T5）、关颅头皮皮下缝合开始后即刻（T6）、拔除气管导管即刻（T7）和拔除气管导管后30min（T8）各时间点记录血流动力学指标。术后恢复阶段观察病人的自主呼吸恢复时间、轻唤睁眼时间、拔管时间，并于拔管后5min记录病人的警觉／镇静评分（OAA／S评分）。结果F组在T2、T3、T6时MAP高于S组（P〈0．05）；S组在T3、T6时的HR低于F组（P〈0．05）；F组的自主呼吸恢复时间、轻唤睁眼时间、拔管时间较S组延长（P〈0．05）；F组拔管后5min OAA／S评分低于S组（P〈0．05）。两组间术中、术后并发症发生率比较差异无统计学意义（P〉0．05）。结论与芬太尼相比较，在神经外科手术时联合应用丙泊酚和舒芬太尼进行全凭静脉麻醉（TIVA），能提供更为稳定的血流动力学，病人术后苏醒快、苏醒质量高，麻醉可控性更好。

Effect of Sufentanil or Fentanyl in Combination with Target-controlled Infusion of Propofol on Patients Undergoing Neurosurgical Operation

Objective To evaluate the effects of sufentanil and fentanyl in combination with target - controlled infusion of propofol on patients undergoing neurosurgical operation. Methods Forty adult patients of ASA grade I - II undergoing elective neurosurgical operation were randomly divided into two groups, i.e. sufentanil group （ Group S, a = 20 ） and fentanyl group （ Group F, n = 20 ）. Anesthesia was induced with midazolam, propofol and sufentanil （ Group S） or fentanyl （Group F）. After tracheal intubation, the patients in Group S received continuous intravenous infusion of sufentanil at a speed of 0.02 - 0.05 μg · kg^-1 ·min^-1 while the patients in Group F received a bolus of fentanyl when it was needed. Anesthesia was maintained by a target-controlled infusion of propofol with a initial target concentration of 2 μg/ml, which was increased progressively until satisfactory anesthesia was achieved. Sufentanil infusion was stopped after skin closure. The anesthetic efficacy of the two groups was evaluated based on hemodynamics （ MAP and HR）at eight time points throughout the operation. After operation, time to spontaneous respiration recovery, eye opening and extubation were recorded. The OAA/S score was evaluated at 5 minutes after extubation. Results The patients in Group F experienced significantly higher MAP after tracheal intubation and headpins insertion （ P 〈 0.05 ）. The patients in Group S experienced significantly lower HR during tumor resection and skin closure （ P 〈 0.05 ）. Time to spontaneous respiration recovery, eye opening and extubation was significantly shorter in Group S than in Group F （ P 〈 0.05 ）. The OAA/S score was significantly better in Group S （ P 〈 0.05 ）. The incidence of postoperative complications was not different （ P 〉 0.05 ）. Conclusion Compared with that of fentanyl, the use of sufentanii infusion in combination with target-controlled infusion of propofol provides a more stable hemodynamics during neurosurgical operation. Recovery