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

发布时间：2018-08-19 10:44

【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(P0.05或P0.01),而SF组变化无统计学意义(P0.05);3组PI和RI均较同组t0期明显升高(P0.05或P0.01);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P0.05);SF组t1~t2期各参数较F组变化幅度更小(P0.05),t3~t4期无统计学差异(P0.05)。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(P0.05);RF组t1~t3期均明显降低(P0.05),且较F组在t1~t3期降低更明显(P0.05),其他组内和组间比较均无统计学意义(P0.05)。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。
[Abstract]:Objective: to compare the cerebral hemodynamic changes of patients with brain injury treated with fentanyl, remifentanil and sufentanil. Methods: 66 patients with craniocerebral injury who were treated in our hospital were randomly divided into 3 groups. Fentanyl was used in group F and SF during induction of general anesthesia on the basis of the same sedation drug as muscle relaxant. Remifentanil and sufentanil were observed before induction (t0), 30 s (T1) and 1 min (T2) after induction, 5 min (T3) and 10 min (t4) after intubation. Results: in terms of cerebral hemodynamic parameters, Qmean and Vmean in the patients in the t1~t4 phase were significantly different from those in the same group at stage t0. Group F and RF decreased significantly (P0.05 or P0.01), but the changes of Pi and RI in SF group were not statistically significant (P0.05). Pi and RI in group F were significantly higher than those in group t0 (P0.05 or P0.01). The Qmean and Vmean in t1~t4 phase in RF group were significantly lower than those in group F (P0.05). The parameters of t1~t2 phase in group F were smaller than those in group F (P0.05), and there was no statistical difference in stage T3 and T4 (P0.05). HR and MAP in F group and SF group were significantly lower in t1~t2 phase than in t0 phase (P0.05) t1~t3 phase in RF group was significantly lower than that in F group in t1~t3 phase (P0.05). There was no significant difference in other groups and between groups (P0.05). Conclusion: remifentanil and sufentanil have the most effect on cerebral hemodynamic parameters in patients with brain injury induced by fentanyl, remifentanil and sufentanil, and sufentanil is more beneficial to the stability of cerebral hemodynamics.
【作者单位】：武警杭州医院;武警浙江省总队机关门诊部;
【分类号】：R614

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