摘要
目的比较全凭静脉麻醉与静吸复合麻醉在颅脑损伤手术中的效果。方法选取2012年1月~2015年4月华北石油管理局总医院收治的颅脑损伤患者88例作为研究对象。根据麻醉方式的不同将所有患者分为观察组（43例）和对照组（45例）。观察组采用异丙酚全凭静脉麻醉,对照组采用异氟醚静吸复合麻醉。观察麻醉诱导前（T_0）、切头皮时（T_1）、切硬脑膜时（T_2）、和术后24 h（T_3）的血流动力学指标[心率（HR）、收缩压（SBP）、舒张压（DBP）、脉搏血氧饱和度（SpO_2）],监测颅内压（ICP）和脑组织氧分压（PbtO_2）参数,检测T_0、T_3时点白介素-1（IL-1）、白介素-6（IL-6）、肿瘤坏死因子α（TNF-α）水平和S100β蛋白含量,记录自主呼吸恢复时间、苏醒时间以及拔管时间。结果对照组T_1、T_2时点HR、SBP、DBP均较T_0时点显著升高,且明显高于观察组同时段,差异均有统计学意义（均P〈0.05）。两组T_1、T_2、T_3时点ICP及PbtO_2与T_0比较,差异均有统计学意义（均P〈0.05）;与对照组比较,观察组T_1、T_2、T_3时点ICP降低更显著,PbtO_2升高更显著,差异均有统计学意义（均P〈0.05）。两组T_3时点IL-1、IL-6、TNF-α水平及S100β蛋白含量均较T_0时点显著升高,差异均有统计学意义（P〈0.05或P〈0.01）,观察组T_3时点上述指标均显著低于对照组,差异均有统计学意义（均P〈0.05）。两组患者自主呼吸恢复时间比较差异无统计学意义（P〉0.05）。观察组苏醒时间、拔管时间均明显短于对照组,差异均有统计学意义（均P〈0.05）。结论全凭静脉麻醉用于颅脑损伤手术血流动力学稳定,能有效降低ICP,提高PbtO_2,具有良好的脑保护作用,且术后恢复快,值得临床推广应用。
Objective To compare the effect of total intravenous anesthesia and intravenous inhalational anesthesia in operation of craniocerebral injury. Methods 88 cases of patients with craniocerebral injury admitted to the General Hospital of North China Detroleum Administration from January 2012 to April 2015 were selected as research objects,all patients were divided into the observation group（43 cases） and the control group（45 cases） according to different ways of anesthesia. The observation group was taken total intravenous anesthesia by Propofol, and the control group was taken intravenous inhalational anesthesia by Isoflurane. The hemodynamic indexes [heart rate（HR）, systolic blood pressure（SBP）, diastolic blood pressure（DBP）, saturation of pulse oximetry（SpO_2）] before anesthesia induction（T_0）, when cutting the scalp（T_1）, when cutting the endocranium（T_2） and postoperative 24 h（T_3） were observed. The parameters of intracranial pressure（ICP） and brain tissue oxygen partial pressure（PbtO_2） were monitored, the levels of interleukin-1（IL-1）, interleukin-6（IL-6）, tumor necrosis factor α（TNF-α） and the content of S100β protein at T_0, T_3 were detected,the recovery time of spontaneous breathing, awakening time and extubation time were recorded. Results The HR, SBP,DBP of the control group at T_1, T_2 were all higher than those at T_0, which were also higher than those of the observation group at the same time points, the differences were all statistically significant（all P〈 0.05）. The differences of ICP and PbtO_2 of the two groups at T_1, T_2, T_3 compared with those at T_0 were all statistically significant（all P 〈0.05）. Compared with the control group, the levels of ICP in observation group at T_1, T_2, T_3 were decreased more obviously, the levels of PbtO_2 were increased more obviously, the differences were all statistically significant（all P〈 0.05）. The levels of IL-1,IL-6, TNF-α and the contents of S100β protein of the two grou
出处
《中国医药导报》
CAS
2016年第10期54-57,共4页
China Medical Herald
关键词
全凭静脉麻醉
静吸复合麻醉
颅脑损伤手术
Total intravenous anesthesia
Intravenous inhalational anesthesia
Operation of craniocerebral injury
