瑞芬太尼与舒芬太尼对重症颅脑损伤患者术后早期认知功能的影响比较
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摘要
目的:对比分析重症颅脑损伤(SCI)围麻醉期分别应用瑞芬太尼和舒芬太尼辅助麻醉对患者术后早期认知功能的影响。方法:选择2017年5月-2018年5月于笔者所在医院行开颅术治疗的126例SCI患者,依据随机数字表法均分成两组。瑞芬太尼组(RF组,63例)于麻醉诱导前10 min静脉泵注瑞芬太尼0.1μg/kg,而后以12.0μg/(kg·h)维持。舒芬太尼组(SF组,63例)于同时点静脉泵注舒芬太尼0.2μg/kg,而后以0.15μg/(kg·h)维持。比较两组各时点[麻醉诱导前(T0)、插管后5 min(T1)、切开脑硬膜时(T2)、苏醒时(T3)]生命体征及脑血流动力学指标变化,苏醒时间,以及术后15 min时简易精神状态量表(MMSE)、瑞秋洛斯阿米哥斯量表(RLAS)评分。结果:两组围术期平均动脉压(MAP)、心率(HR)对比差异均无统计学意义(P>0.05)。与SF组相比,RF组T1、T2、T3时脑血流动力学参数[平均血流量(Qmean)、平均血流速度(Vmean)]值明显更低(P<0.05)。RF组苏醒时间显著早于SF组(P<0.01),而术后15 min时MMSE、RLAS评分均显著高于SF组(P<0.01)。结论:在SCI围麻醉期采取舒芬太尼辅助麻醉较瑞芬太尼更有助于维持患者生命体征及脑血流动力学状态稳定,但瑞芬太尼在改善SCI患者术后早期认知功能方面优势突出。
Objective:To compare analyze of the effects of Remifentanil and Sufentanil anesthesia on early cognitive function in patients with severe craniocerebral injury(SCI) during anesthesia.Method:From May 2017 to May 2018,126 cases with SCI who underwent craniotomy in our hospital were selected,and divided them into two groups randomly.Remifentanil group(RF group,63 cases) was intravenously injected with Remifentanil 0.1 μg/kg 10 min before anesthesia induction,and then maintained at 12.0 μg/(kg·h).Sufentanil group(SF group,63 cases) was intravenous pumped with Sufentanil 0.2 μg/kg at the same time and then maintained at 0.15 μg/(kg·h).Two groups' vital signs and changes in cerebral hemodynamics at each time[before anesthesia induction(T0), 5 minutes after intubation(T1),incision of the brain dura(T2),and recovery(T3)],scores of Simple Mental State Scale(MMSE) and Rancho Los Amigos Scale(RLAS) in wakeup time and 15 minutes after surgery were compared.Result:Here was no statistical significance in mean arterial pressure(MAP)and heart rate(HR)during perioperative period between two groups(P>0.05).Compared with those in SF groups,RF group's cerebral hemodynamic parameters[mean blood flow(Qmean),mean blood flow velocity(Vmean)] at T1,T2,T3 were significant lower(P<0.05).RF group's wakeup time was significant shorter than that in SF group(P<0.01),and MMSE,RLAS scores at 15 minutes after surgery were significant higher than those in SF group(P<0.01).Conclusion:Sufentanil-assisted anesthesia during SCI perianesthesia is more helpful than remifentanil to maintain vital signs and cerebral hemodynamics,but Remifentanil has outstanding advantages in help patients with SCI to improve early cognitive function.
Objective:To compare analyze of the effects of Remifentanil and Sufentanil anesthesia on early cognitive function in patients with severe craniocerebral injury(SCI) during anesthesia.Method:From May 2017 to May 2018,126 cases with SCI who underwent craniotomy in our hospital were selected,and divided them into two groups randomly.Remifentanil group(RF group,63 cases) was intravenously injected with Remifentanil 0.1 μg/kg 10 min before anesthesia induction,and then maintained at 12.0 μg/(kg·h).Sufentanil group(SF group,63 cases) was intravenous pumped with Sufentanil 0.2 μg/kg at the same time and then maintained at 0.15 μg/(kg·h).Two groups' vital signs and changes in cerebral hemodynamics at each time[before anesthesia induction(T0), 5 minutes after intubation(T1),incision of the brain dura(T2),and recovery(T3)],scores of Simple Mental State Scale(MMSE) and Rancho Los Amigos Scale(RLAS) in wakeup time and 15 minutes after surgery were compared.Result:Here was no statistical significance in mean arterial pressure(MAP)and heart rate(HR)during perioperative period between two groups(P>0.05).Compared with those in SF groups,RF group's cerebral hemodynamic parameters[mean blood flow(Qmean),mean blood flow velocity(Vmean)] at T1,T2,T3 were significant lower(P<0.05).RF group's wakeup time was significant shorter than that in SF group(P<0.01),and MMSE,RLAS scores at 15 minutes after surgery were significant higher than those in SF group(P<0.01).Conclusion:Sufentanil-assisted anesthesia during SCI perianesthesia is more helpful than remifentanil to maintain vital signs and cerebral hemodynamics,but Remifentanil has outstanding advantages in help patients with SCI to improve early cognitive function.
引文
[1]刘杰,陈伟.瑞芬太尼与舒芬太尼对颅脑损伤患者术后早期认知功能恢复的影响[J].中国实用神经疾病杂志,2015,18(7):104-105.
[2]王依慰,陈春龙,支亦博,等.瑞芬太尼与舒芬太尼全身麻醉后对患者苏醒质量影响的Meta分析[J].医学研究生学报,2016,29(2):170-177.
[3]任波,白晓光.瑞芬太尼和舒芬太尼术中麻醉效果比较[J].中国煤炭工业医学杂志,2015,18(7):1068-1070.
[4]张秀山,张彦,孟春,等.瑞芬太尼与舒芬太尼对老年神经外科术后患者早期认知功能的影响[J].中华老年医学杂志,2011,30(4):316-318.
[5]吴帮林,闫诺,赵卓,等.神经外科手术患者麻醉术后认知功能障碍机制探讨[J].新乡医学院学报,2015,32(8):791-793.
[6]田学章,陈腊梅,唐湘鄂,等.舒芬太尼与芬太尼用于神经外科手术麻醉的临床分析[J].中国现代药物应用,2013,7(13):134-135.
[7]赵小飞,毛婷婷.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[J].中国医院药学杂志,2015,35(4):333-336.
[8]陈新忠,赵琳,李文,等.唤醒麻醉开颅术中普鲁泊福复合瑞芬太尼或舒芬太尼对认知功能的影响[J].中国医师进修杂志,2010,33(30):16-19.
[9]吴艳,万意,贾维桂.丙泊酚联合芬太尼麻醉应用于重型颅脑损伤急诊手术患者对其脑血流动力学及认知功能的影响分析[J].临床和实验医学杂志,2017,16(22):2209-2212.
[10]范寿成,王宏江,陈小军.瑞芬太尼对重型颅脑损伤患者脑氧代谢改善作用[J].昆明医科大学学报,2015,36(7):123-125.
[11]黄艺文,兰雨雁,江朝秀.七氟醚与丙泊酚联合瑞芬太尼麻醉在神经外科手术中的应用效果比较[J].广西医学,2018,40(4):385-388.
[12]张康秦,梁斌,赵蕊,等.舒芬太尼、瑞芬太尼在急诊脑外伤手术麻醉中的临床应用[J].现代生物医学进展,2016,16(33):6570-6572.
[2]王依慰,陈春龙,支亦博,等.瑞芬太尼与舒芬太尼全身麻醉后对患者苏醒质量影响的Meta分析[J].医学研究生学报,2016,29(2):170-177.
[3]任波,白晓光.瑞芬太尼和舒芬太尼术中麻醉效果比较[J].中国煤炭工业医学杂志,2015,18(7):1068-1070.
[4]张秀山,张彦,孟春,等.瑞芬太尼与舒芬太尼对老年神经外科术后患者早期认知功能的影响[J].中华老年医学杂志,2011,30(4):316-318.
[5]吴帮林,闫诺,赵卓,等.神经外科手术患者麻醉术后认知功能障碍机制探讨[J].新乡医学院学报,2015,32(8):791-793.
[6]田学章,陈腊梅,唐湘鄂,等.舒芬太尼与芬太尼用于神经外科手术麻醉的临床分析[J].中国现代药物应用,2013,7(13):134-135.
[7]赵小飞,毛婷婷.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[J].中国医院药学杂志,2015,35(4):333-336.
[8]陈新忠,赵琳,李文,等.唤醒麻醉开颅术中普鲁泊福复合瑞芬太尼或舒芬太尼对认知功能的影响[J].中国医师进修杂志,2010,33(30):16-19.
[9]吴艳,万意,贾维桂.丙泊酚联合芬太尼麻醉应用于重型颅脑损伤急诊手术患者对其脑血流动力学及认知功能的影响分析[J].临床和实验医学杂志,2017,16(22):2209-2212.
[10]范寿成,王宏江,陈小军.瑞芬太尼对重型颅脑损伤患者脑氧代谢改善作用[J].昆明医科大学学报,2015,36(7):123-125.
[11]黄艺文,兰雨雁,江朝秀.七氟醚与丙泊酚联合瑞芬太尼麻醉在神经外科手术中的应用效果比较[J].广西医学,2018,40(4):385-388.
[12]张康秦,梁斌,赵蕊,等.舒芬太尼、瑞芬太尼在急诊脑外伤手术麻醉中的临床应用[J].现代生物医学进展,2016,16(33):6570-6572.