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
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摘要
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。
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-t4thant0in3 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-~t4than t0in3 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 t0in F group and SF group(P<0.05),at t1-t3 than t0in 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.
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-t4thant0in3 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-~t4than t0in3 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 t0in F group and SF group(P<0.05),at t1-t3 than t0in 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.
引文
[1]于向东,邱虹.颅脑损伤患者气管切开术后下呼吸道感染的防治[J].中国医院药学杂志,2010,30(7):591-592.
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[9]刘江红,曾伟强,李志坚,等.依达拉奉对高血压脑出血脑氧代谢及脑血管血液动力学参数的影响[J].检验医学与临床,2013,10(13):1666-1669.
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[11]祝义军,冉国,鲍杨,等.芬太尼舒芬太尼和瑞芬太尼在老年人全麻诱导时引起心动过缓的比较[J].中国医院药学杂志,2013,33(18):1509-1512.
[12]马珏,陈怡静,赵国栋.舒芬太尼与瑞芬太尼对全麻气管插管时心血管反应和Narcotrend参数影响的对比研究[J].实用医学杂志,2013,29(17):2878-2880.
[13]张彦,梁禹,张秀山,等.丙泊酚舒芬太尼与丙泊酚雷米芬太尼用于颅脑外科唤醒麻醉的临床观察[J].天津医药,2010,38(5):424-426.
[14]Servin FS,Billard V.Remifentanil and other opioids[J].Handb Exp Pharmacol,2008,18(2):283-311.
[15]Zhang Guo-hua,Sun Li.Peri-intubation hemodynamic changes during low dose fentanyl.remifentaniI and sufentanil combined with etomidate for anesthetic induction[J].Chin Med J(Engl),2009,122:2330-2334.
[16]赵昕,邢彦杰,张树立,等.舒芬太尼复合丙泊酚对急性高血压脑出血手术患者血流动力学的影响[J].河北联合大学学报(医学版),2013,15(3):300-302.
[2]毛晓茹.急性颅脑损伤临床麻醉处理分析[J].现代预防医学,2010,37(5):961-965.
[3]毛福胜.52例颅脑损伤患者急诊手术的麻醉分析[J].中国医药导报,2010,7(23):89-93.
[4]夏尚伏.严重创伤性脑损伤麻醉处理相关研究进展[J].人民军医,2012,55(9):885-907.
[5]刘宝江,王守臣,赵爱军,等.经颅多普勒检测颅脑损伤后早期脑血流动力学变化研究[J].现代中西医结合杂志,2012,21(23):2513-2519.
[6]阳定安,饶正伟.血流动力学指标检测在大面积脑梗死中的诊断价值研究[J].现代预防医学,2012,39(17):4533-4539.
[7]Buder N,Pellissier D,Grillot P,et al.Cerebral hyperemia during recovery from general anesthesia in neurosurgical patients[J].Anesth Analg,2002,94(3):650-654.
[8]杨玲玲.继发性脑损伤手术麻醉方式及管理体会[J].中国实用神经疾病杂志,2013,16(4):89-90.
[9]刘江红,曾伟强,李志坚,等.依达拉奉对高血压脑出血脑氧代谢及脑血管血液动力学参数的影响[J].检验医学与临床,2013,10(13):1666-1669.
[10]钟诚,王彬,刘宇,等.高压氧治疗对重型颅脑损伤患者脑血管血流动力学参数的影响[J].中国实用神经疾病杂志,2013,16(19):28-30.
[11]祝义军,冉国,鲍杨,等.芬太尼舒芬太尼和瑞芬太尼在老年人全麻诱导时引起心动过缓的比较[J].中国医院药学杂志,2013,33(18):1509-1512.
[12]马珏,陈怡静,赵国栋.舒芬太尼与瑞芬太尼对全麻气管插管时心血管反应和Narcotrend参数影响的对比研究[J].实用医学杂志,2013,29(17):2878-2880.
[13]张彦,梁禹,张秀山,等.丙泊酚舒芬太尼与丙泊酚雷米芬太尼用于颅脑外科唤醒麻醉的临床观察[J].天津医药,2010,38(5):424-426.
[14]Servin FS,Billard V.Remifentanil and other opioids[J].Handb Exp Pharmacol,2008,18(2):283-311.
[15]Zhang Guo-hua,Sun Li.Peri-intubation hemodynamic changes during low dose fentanyl.remifentaniI and sufentanil combined with etomidate for anesthetic induction[J].Chin Med J(Engl),2009,122:2330-2334.
[16]赵昕,邢彦杰,张树立,等.舒芬太尼复合丙泊酚对急性高血压脑出血手术患者血流动力学的影响[J].河北联合大学学报(医学版),2013,15(3):300-302.