摘要
目的分析丙泊酚联合芬太尼麻醉对重型颅脑损伤急诊手术患者的脑血流动力学及认知功能的影响。方法回顾性分析2014年1月至2017年2月收治的伤后24 h内的急性重型颅脑损伤72例患者,随机分为观察组和对照组各36例。对照组均气管插管后吸入异氟醚维持麻醉,观察组均给予芬太尼与丙泊酚联合麻醉处理。比较两组患者诱导前(T0)、诱导后1 min(T1)、插管后5 min(T2)、插管后10 min(T3)时间点的脑血流动力学参数、心率(HR)及平均动脉压(MAP),此外采用简易智能精神状态量表(MMSE)评定两组患者手术前后的神经精神功能,并通过MMSE评分认定两组患者认知功能缺损(POCD)情况。结果两组患者T1~T3期较同组T0期Qmean和Vmean均出现不同程度的变化,对照组显著降低(P<0.05),而观察组变化差异无统计学意义(P>0.05);两组PI指数和RI指数均较T0期显著升高(P<0.05),观察组T1期各参数较对照组变化幅度更小(P<0.05),T2~T3期差异无统计学意义(P>0.05);T1期两组患者的HR和MAP均较T0期显著降低(P<0.05),T2期、T3期较T0期比较差异无统计学意义(P>0.05),组间同期比较差异亦无统计学意义(P>0.05)。相较于术前,术后1 d两组的MMSE评定均明显减低(P<0.05),相较于对照组,术后1 d观察组患者的MMSE评分下降较少(P<0.05),两组患者术后1周及1个月的MMSE评分与术前比较,差异无统计学意义(P>0.05)。术后1 d,观察组POCD的发生率明显低于对照组(P<0.05),此外术后1周对照组尚有3例POCD患者,此时观察组已无POCD患者。结论对重型颅脑损伤患者采用丙泊酚与芬太尼联合麻醉,有利于患者脑血流动力学的稳定,对患者的认知功能影响更小,可有效降低术后患者认知功能障碍的发生,值得推广应用。
Objective To analyze the clinical curative effect of combination-applica tion of propofol and fentanyl for severe craniocerebral injury patients with emergency surgery. Methods 72 cases of patients within 24 h after injury of acute severe craniocerebral injury from January 2014 to February 2017 were selected as the research object and retrospectively analyzed. they were randomly divided into the observation group and the control group,36 cases in each group. The control group were given isoflurane to maintain anesthesia,while the observation group were given propofol combined with fentanyl to anesthetize. Cerebral hemodynamic parameters,HR and MAP of two groups of patients before induction（ T0）,1 min after induction（ T1）,5 min after intubation（ T2）,10 min after intubation（ T3）. Moreover,compared cognitive recovery ability of two groups by MMES rating scale were compared. Results Compared with those of the same group at the stage t0,Qmean and Vmean of two groups of patients at the stage T1 ~ T3 varied in different degrees,and the control group decreased significantly（ P 〈 0. 05）,but the observation group’s change had no statistical significant difference（ P 〉 0. 05）. PI and RI in two groups were comparable to a significant rise in period（ P 〈0. 05）. Each parameter in T1 phase of the observation group was smaller than that of control group（ P 〈 0. 05）. T2 to T3 has no statistical difference（ P 〉 0. 05）. Compared with those of two groups at the stage t0,HR and MAP of them at the stage T1 were significantly decreased（ P 〈0. 05）. There was no statistically significant difference between groups and within group（ P 〉 0. 05）. Compared with preoperative,the MMSE evaluation in two groups of postoperative 1 d were significantly lower（ P 〈 0. 05）. Compared with the control group,the MMSE score of the observation groups less decreased after 1 day,that had statistical significance（ P 〈 0. 05）. MMSE score in two groups postoperative 1 week and 1 month compa
出处
《临床和实验医学杂志》
2017年第22期2209-2212,共4页
Journal of Clinical and Experimental Medicine
基金
江苏省基础研究计划(自然科学基金)面上研究项目(编号:BK2011341)
