李文昌 杨海丽 任立新 肖 剑 乐 婷华北石油管理局总医：麻醉科，河北任丘062552

    全凭静脉麻醉与静吸复合麻醉在颅脑损伤手术中的效果比较

    李文昌杨海丽任立新肖剑乐婷

    华北石油管理局总医：麻醉科，河北任丘062552

    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：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(T0)、切头皮时(T1)、切硬脑膜时(T2)、和术后24 h(T3)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(SpO2)]，监测颅内压(ICP)和脑组织氧分压(PbtO2)参数，检测T0、T3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T1、T2时点HR、SBP、DBP均较T0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T1、T2、T3时点ICP及PbtO2与T0比较，差异均有统计学意义(均P<0.05)；与对照组比较，观察组T1、T2、T3时点ICP降低更显著，PbtO2升高更显著，差异均有统计学意义(均P<0.05)。两组T3时点IL-1、IL-6、TNF-α水平及S100β蛋白含量均较T0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T3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PbtO2，具有良好的脑保护作用，且术后恢复快，值得临床推广应用。

    全凭静脉麻醉；静吸复合麻醉；颅脑损伤手术

    [Abstract]Objective To compare the effect of tota1 intravenous anesthesia and intravenous inha1ationa1 anesthesia in operation of craniocerebra1 injury.Methods 88 cases of patients with craniocerebra1 injury admitted to the Genera1 Hospita1 of North China Detro1eum Administration from January 2012 to Apri1 2015 were se1ected as research objects, a11 patients were divided into the observation group(43 cases)and the contro1 group(45 cases)according to different ways of anesthesia.The observation group was taken tota1 intravenous anesthesia by Propofo1,and the contro1 group was taken intravenous inha1ationa1 anesthesia by Isof1urane.The hemodynamic indexes[heart rate(HR),systo1ic b1ood pressure(SBP),diasto1ic b1ood pressure(DBP),saturation of pu1se oximetry(SpO2)]before anesthesia induction(T0),when cutting the sca1p(T1),when cutting the endocranium(T2)and postoperative 24 h(T3)were observed.The parameters of intracrania1 pressure(ICP)and brain tissue oxygen partia1 pressure(PbtO2)were monitored,the 1eve1s of inter1eukin-1 (IL-1),inter1eukin-6(IL-6),tumor necrosis factor α(TNF-α)and the content of S100β protein at T0,T3were detected, the recovery time of spontaneous breathing,awakening time and extubation time were recorded.Results The HR,SBP, DBP of the contro1 group at T1,T2were a11 higher than those at T0,which were a1so higher than those of the observation group at the same time points,the differences were a11 statistica11y significant(a11 P<0.05).The differences of ICP and PbtO2of the two groups at T1,T2,T3compared with those at T0were a11 statistica11y significant(a11 P<0.05).Compared with the contro1 group,the 1eve1s of ICP in observation group at T1,T2,T3were decreased more obvious1y,the 1eve1s of PbtO2were increased more obvious1y,the differences were a11 statistica11y significant(a11 P<0.05).The 1eve1s of IL-1, IL-6,TNF-α and the contents of S100β protein of the two groups at T3were a11 higher than those at T0,the differences were a11 statistica11y significant(P<0.05 or P<0.01),the indexes above in the observation group at T3were a11 1ower than those of the contro1 group,the differences were a11 statistica11y significant(a11 P<0.05).The differences of the re-covery time of spontaneous breathing between the two groups were not statistica11y significant(P>0.05).The awakening time and extubation time of the observation group were a11 shorter than those of the contro1 group,the differences were a11 statistica11y significant(a11 P<0.05).Conclusion App1ication of tota1 intravenous anesthesia in operation of craniocerebra1 injury has stab1e haemodynamics,which can significant1y decrease ICP,increase PbtO2,with good cerebra1 protection effect and fast postoperative recovery.It is worthy of c1inica1 promotion and app1ication. ......