脑损伤患者应用芬太尼、瑞芬太尼和舒芬太尼的脑血流动力学比较

目的:比较脑损伤患者应用芬太尼、瑞芬太尼和舒芬太尼的脑血流动力学变化情况,为临床提供参考。方法:选择于我院就诊治疗的66例颅脑损伤患者的病例,随机分为3组,在肌松与镇静药相同的基础上,F组(n=22)、RF组(n=22)和SF组(n=22)在全麻诱导期分别应用芬太尼、瑞芬太尼和舒芬太尼;于诱导前(t₀)、诱导后30 s(t₁)和1 min(t₂)、插管后5 min(t₃)和10 min(t₄)观察3组的脑血流动力学参数(包括:Qmean、Vmean、PI和RI),同时监测HR和MAP。结果:在脑血流动力学参数方面,3组患者在t₁~t₄期,Qmean和Vmean均较同组t₀期不同程度变化,其中F组和RF组显著降低(P<0.05或P<0.01),而SF组变化无统计学意义(P>0.05);3组PI和RI均较同组t₀期明显升高(P<0.05或P<0.01);RF组t₁~t₄期Qmean和Vmean较F组降低更明显、PI和RI升高也更明显(均为P<0.05);SF组t₁~t₂期各参数较F组变化幅度更小(P<0.05),t₃~t₄期无统计学差异(P>0.05)。在HR和MAP方面,F组和SF组患者在t₁~t₂期均较t₀期明显降低(P<0.05);RF组t₁~t₃期均明显降低(P<0.05),且较F组在t₁~t₃期降低更明显(P<0.05),其他组内和组间比较均无统计学意义(P>0.05)。结论:脑损伤患者应用等效浓度的芬太尼、瑞芬太尼和舒芬太尼诱导麻醉时,以瑞芬太尼对脑血流动力学参数影响最大,芬太尼次之,舒芬太尼更有利于脑血流动力学的稳定。

Comparative study on cerebral hemodynamics of fentanyl,remifentanil and sufentanil in patients with cerebral injuries

OBJECTIVE To compare the changes of cerebral hemodynamics of fentanyl, remifentanil and sufentanil in patients with cerebral injuries, and provide reference for clinical practice.METHODS The clinical data of 66 patients with traumatic cerebral injuries were randomly divided into 3 groups, fentanyl, remifentanil and sufentanil were applied in F group (n=22), RF group (n=22) and SF group (n=22), respectively at the time of induction of anesthesia on the basis of the same muscle relaxants and sedatives. Cerebral hemodynamic parameters (including: Qmean, Vmean, PI and RI), HR and MAP were observed before induction (t₀), 30 s (t₁) and 1 min (t2) after induction, 5min (t₃) and 10min (t₄) after intubation.RESULTS When cerebral hemodynamic parameters were compared, the Qmean and Vmean changed differently at t₁-t₄ than t₀ in 3 groups, which were significant in F group and RF group (P<0.05 or P<0.01), not significant in SF group (P>0.05). The PI and RI were significantly higher (P<0.05 or P<0.01) at t₁-~t₄ than t₀ in 3 groups. Vmean and Qmean decreased and PI and RI increased more significantly (P<0.05) in RF group than in F group at t₁-t₄. The changes were smaller (P<0.05) in SF group than in F group at t₁-t₂, without statistical significance (P>0.05) at t₃-t₄. For HR and MAP, their decreases were significant at t₁-t₂ than t₀ in F group and SF group (P<0.05), at t₁-t₃ than t₀ in RF group (P<0.05), and at t₁-t₃ in SF group than in F group (P<0.05). No other significant difference was observed in groups or between groups (P>0.05). CONCLUSION When anesthesia is induced by fentanyl, remifentanil or sufentanil at equal concentrations, remifentanil has the most significant effects on cerebral hemodynamics parameters in patients with cerebral injuries, followed by fentanyl. While sufentanil is more helpful to stability of cerebral hemodynamics.