全凭静脉麻醉和静吸复合全麻在颅脑手术中应用效果分析

目的探讨全凭静脉麻醉与静吸复合麻醉在颅脑手术中的临床麻醉效果,比较两种麻醉方法对围术期应激反应的影响,为寻求麻醉安全方式提供依据。方法收集2009年1月~2012年12月于深圳市光明新区人民医院行颅脑损伤手术治疗的患者,其中,全凭静脉麻醉患者45例作为观察组,静吸复合麻醉患者52例作为对照组,比较两组血流动力学变化、血清IL-6、肾上腺素（ADR）、去甲肾上腺素（NADR）的浓度变化以及自主呼吸恢复时间、苏醒时间、拔管时间、定向力恢复时间、术后24 h不良反应发生情况。结果两组患者心率、平均动脉压在术中、术后24 h均较麻醉前基础值升高,对照组上升较观察组明显（P〈0.05）;两组患者血清IL-6在术中、术后24 h均较麻醉前基础值升高（P〈0.05）,对照组上升较观察组明显（P〈0.05）;对照组术中、术后24 h血清ADR、NADR浓度升高（P〈0.05）,观察组术中血清ADR、NADR浓度有所下降,术后24 h升高（P〈0.05）;两组患者BIS在术中较麻醉前基础值明显下降（P〈0.05）,对照组较观察组明显下降（P〈0.05）;观察组术后苏醒时间（5.47±2.27）min]、拔管时间（8.92±2.14）min]、定向力恢复时间（15.81±5.95）min]均明显短于对照组的苏醒时间（8.97±2.51）min]、拔管时间（13.45±4.93）min]、定向力恢复时间（24.14±7.25）min],两组差异有高度统计学意义（P〈0.01）。观察组术后恶心呕吐发生率（2.22%）明显低于对照组（17.31%）（P〈0.05）。结论全凭静脉麻醉与静吸复合麻醉在颅脑损伤手术中比较,血流动力学更稳定,创伤所产生的应激反应更少,拔管期更加平稳,且不良反应明显减少。

Application study of total intravenous and combined intravenous and inhalation anesthesia in neurosurgical procedures

Objective To investigate the clinical anesthesia effects of the total intravenous anesthesia and intravenousinhalation anesthesia, compare effects of the two anesthesia methods on perioperative stress response, in order to provide basis for seeking safe anesthesia method. Methods Patients underwent craniocerebral trauma surgery in People＇s Hospital of Guangming New District in Shenzhen City from January 2009 to December 2012 were selected. 45 cases of patients with total intravenous anesthesia were treated as the observation group, and 52 cases with intravenous-inhalation anesthesia were treated as the control group at the same time. Then the hemodynamic changes, serum concentrations of IL-6, adrenalin （ADR） and noradrenalin （NADR）, time of recovering spontaneous breathing, eye opening, extubation and orientation after termination of anesthesia, adverse reaction at 24 h after surgery between the two groups were compared. Results Intraoperative and postoperative 24 h HR, MAP were higher than the baselines, and those in the control group were significant higher than those in the observation group （P 〈 0.05）. Intraoperative and postoperative 24 h IL-6 was higher than the baselines, and that in the control group was significantly higher than that in the observation group （P 〈 0.05）. Intraoperative and postoperative 24 h serum ADR and NADR increased significantly in the con- trol group （P 〈 0.05）; while in the observation group, ADR and NADR decreased during opreration and increased at the first day after operation （P 〈0.05）. Intraoperative and postoperative 24 h BIS was lower than the baselines, and that in the control group was significantly lower than in the observation group （P 〈 0.05）. The time of eye opening （5.47±2.27） mini, extubation （8.92±2.14） rain] and orientation after termination （15.81±5.95） min] of anesthesia in the observation group were significant shorter than those in the control group （8.97±2.51）, （13.45±4.93）, （24.14±7.25） min] （P 〈 0.05）. The occurrence of nausea and vomiting in observation group （2.22%） was significant lower than that in control group （17.31%） （P 〈 0.05）. Conclusion Compared with intravenous-inhalation anesthesia, the total intravenous anesthesia can make patients have more stable hemodynamics and reduce the stress response produced by trauma, have more smooth in extubation period and improve the quality of anesthesia, and the adverse effects rate is lower.