摘要
目的观察颅脑外伤手术中应用不同剂量舒芬太尼对血流动力学变化的影响。方法选择40例ASA评分Ⅱ到Ⅳ级颅脑外伤手术病人,随机均分为A组和B组。麻醉诱导采用A组舒芬太尼0.4ug/kg,B组舒芬太尼0.55ug/kg,气管插管后机械通气,术中A组静脉持续泵入舒芬太尼0.2ug/(kg.h),B组舒芬太尼0.3ug/(kg.h)。记录诱导前(基础值)、切皮时、开颅时、去骨瓣时、手术结束时的平均动脉压(MAP)、心率(HR)。结果与诱导插管前相比,2组病人的血压及心率均有所下降(P【0.05),A组病人插管时,插管后1、3min平均动脉压(MAP)、心率(HR)较插管前有所升高(P【0.05),手术中切皮时、开颅时、去骨瓣时、手术结束时的平均动脉压(MAP)、心率(HR)均有不同程度的增高,需要加用镇静镇痛或降血压药物;B组病人诱导前(基础值)、切皮时、开颅时、去骨瓣时、手术结束时的平均动脉压(MAP)、心率(HR)变化不明显。结论在颅脑外伤手术麻醉诱导采用舒芬太尼0.55ug/kg,麻醉维持采用舒芬太尼0.3ug/(kg.h)能更好地维持血流动力学稳定。
Objective To observe the effects of different dose of sufentanil on hemodynamics of patients with traumatic brain injury.Methods A total of forty ASA physical status Ⅱto Ⅳ patients scheduled for neurosurigical surgery were randomized to A or B group(20 for each).Induction of anesthesia was began with sufentanil 0.4ug/kg,group B sufentanil 0.55ug/kg.Mechanical wentilation was performed after tracheal intubation,followed by continuous intracenous pumping of sufentanil(0.2ug/(kg·h))(group A)or sufentanil(0.3ug/(kg·h))(group B).The patient’s blood pressure,heart rate before endotracheal intubation(baseline value),cutting skin,craniectomy,at the end of operation were continuously recorded.Result:In group A,the patient’s blood pressure,the Heart Rate(HR)during cutting skin,craniectomy,at the end of operation were high than baseline value(P<0.05),spontaneous breath recovery and after tracheal extubation were higher than baseline value(P<0.05),but group B was not different from baseline value(P<0.05).Conclusion B group is more stable apllying in the anesthesia induction(sufentanil 0.55 ug/kg)and maintenance in intracranial surgery.
关键词
舒芬太尼
颅脑外伤
全麻
血流动力学
Sufentanil
Traumatic brain injury
General anesthesia
Hemodynamics
