异丙酚与七氟醚复合舒芬太尼对颅内肿瘤手术中脑组织氧代谢的影响比较

【目的】探讨异丙酚与七氟醚分别复合舒芬太尼对脑组织氧代谢的影响。【方法】本院收治的颅内肿瘤患者58例，按照麻醉方式不同分为 A 组（异丙酚复合舒芬太尼）和 B 组（七氟醚复合舒芬太尼），每组29例。 A 组静脉注射异丙酚＋舒芬太尼＋顺苯磺阿曲库铵，B 组静脉注射咪达唑仑＋舒芬太尼＋顺苯磺阿曲库铵，术中同时使用七氟醚维持麻醉，监测手术插管后5 min（T1）、切开硬膜（T2）、取瘤后30 min（T3）、手术结束（T4）和拔管时（T5）5个时间段患者的心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、颈内静脉血氧饱和度（SjvO2）以及脑动静脉血氧分压（Da‐jvO2）以及麻醉情况。【结果】A 组各时间段 HR 、MAP 及 SpO2变化均较平稳，与 B 组同时间点比较差异有显著性（ P ＜0．05）。 A 组 T2、T3、T4时段的 SjvO2水平明显高于 T1时段（ P ＜0．05），T2、T3、T4时段的 Da‐jvO2水平明显低于 T1时段（ P ＜0．05）；与 B 组比较，A 组在 T2、T3、T4时段的 SjvO2水平和Da‐jvO2水平改善更明显，组间比较差异有显著性（ P ＜0．05）。两组的麻醉时间相比较无明显差异（ P ＞0．05）， A 组清醒拔管时间和住院时间短于 B 组且差异有显著性（ P ＜0．05）。【结论】异丙酚复合舒芬太尼麻醉应用于颅脑肿瘤患者手术具有血流动力学平稳，能够平衡脑氧供需，降低脑氧代谢率以及安全性高等特点，且麻醉后清醒时间较短，有利于患者术后恢复。

Effect of Propofol and Sevoflurane Combined with Sufentanil on Qxygen Metabolism in Brain Tis-sue

Objective]To investigate the effect of propofol and sevoflurane combined with sufentanil repective‐ly on oxygen metabolism in brain tissue .Methods] Fifty‐eight cases of intracranial tumors admitted in our hospi‐tal were selected ,and were divided into group A (propofol and sufentanil) and group B (sufentanil and sevoflu‐rane) ,according to the different ways of anesthesia ,29 cases in each group .The Group A received intravenous in‐jection of propofol + sufentanil + cisatracurium besylate ,and the Group B was injected intravenously with mid‐azolam + sufentanil + cisatracurium besylate .At the same time ,sevoflurane was used to maintain anesthesia . The indexes of heart rate (HR) ,mean arterial pressure (MAP) ,pulse oxygen saturation (SpO2 ) ,internal jugu‐lar venous oxygen saturation (SjvO2 ) and cerebral arteriovenous oxygen partial pressure (Da‐jvO2 ) of 5 stages like 5min after intubation (T1 ) ,dural incision (T2 ) ,post removal of tumor 30min (T3 ) ,by the end of surgery (T4 ) and extubation time (T5 ) were monitored during the surgery .Anesthesia efficacy was compared .Results]The changes of HR ,MAP and SpO2 in the Group A were more stable than that in the Group B ,and the difference was significant at the same time point ( P < 0 .05) .The SjvO2 level in T2 ,T3 ,T 4 period was significantly higher than that in T1 period ( P < 0 .05) ,the Da‐jvO2 level in T2 ,T3 ,T4 period was significantly lower than that in T1 peri‐od (P < 0 .05) ;compared with the B group ,the SjvO2 level of group A in T2 ,T3 ,T4 period and the Da‐jvO2 lev‐el were improved more obviously ,and there was significant difference between groups ( P < 0 .05) .There was no significant difference in comparison of anesthesia time between the two groups ( P > 0 .05) .Compared with the Group B ,there was significant difference in the time of extubation and length of stay in the A Group ( P < 0 .05) .Conclusion] Propofol combined with sufentanil anesthesia in patients with brain tumors is able to maintain hemo‐dynamics ,balance the cerebral oxygen supply and demand and reduce the rate of cerebral oxygen metabolism with high security ,and awake time after anesthesia is shorter .It is conducive to the recovery of patients after surgery .