本文選題：瑞芬太尼 + 七氟烷�。� 參考：《石河子大學(xué)》2017年碩士論文

【摘要】：目的:探討在顱腦手術(shù)患者中不同麻醉藥物之間兩兩聯(lián)合進(jìn)行控制性降壓對腦脂質(zhì)過氧化損傷的影響。方法:選擇全身麻醉下?lián)衿谛虚_顱顱內(nèi)占位切除術(shù)的神經(jīng)膠質(zhì)瘤患者(術(shù)后病理切片已確診)120例為研究對象。將所有患者隨機(jī)分為四組進(jìn)行控制性降壓(CH):瑞芬太尼+七氟烷(RS)組、瑞芬太尼+丙泊酚(RP)組、七氟烷+丙泊酚(SP)組、硝酸甘油(N)組。所有患者均在剪開硬腦膜后開始實(shí)施CH,各組患者平均動脈壓(MAP)均在10分鐘內(nèi)下降術(shù)前基礎(chǔ)值的30%。手術(shù)醫(yī)師關(guān)閉硬腦膜后停止實(shí)施CH。所有患者均連續(xù)監(jiān)測平均動脈壓(MAP)、心率(HR)及局部腦氧飽和度(r Sc O2),并分別于全麻誘導(dǎo)前(T1)、使用頭皮拉鉤固定頭皮后(T2)、CH開始后10分鐘(T3)、CH開始后30分鐘(T4)、CH停止后30分鐘(T5)五個時間點(diǎn)記錄。同時,分別于五個時間點(diǎn)采集頸內(nèi)靜脈血和橈動脈血各3ml至真空試管,迅速置于-80℃冰箱內(nèi)以備檢測超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量,并于T4時間點(diǎn)記錄腦電雙頻指數(shù)(BIS)及術(shù)野質(zhì)量評分(SSFQ)。結(jié)果:各組組內(nèi)比較,T3、T4、T5較T1時間點(diǎn)動脈、靜脈中SOD活性明顯下降(P0.05),而靜-動脈之差則呈增大趨勢(P0.05)。在T3、T4、T5時間點(diǎn),N組較RP組、RS組、SP組動脈、靜脈中SOD活性明顯減少(P0.05),靜-動脈之差則明顯增大(P0.05)。在T4時間點(diǎn),RP組較RS組、SP組,SOD活性靜-動脈之差明顯增大(P0.05),而RS組與SP組之間則差異無統(tǒng)計(jì)學(xué)意義(P0.05)。各組組內(nèi)比較,T3、T4、T5較T1時間點(diǎn)動脈、靜脈中MDA含量及靜-動脈之差均呈明顯上升趨勢(P0.05)。在T3、T4、T5時間點(diǎn),N組較RP組、RS組、SP組靜脈中MDA含量及靜-動脈之差均呈明顯增加(P0.05)。在T4時間點(diǎn),RP組較RS組、SP組,靜脈MDA含量及靜-動脈之差呈明顯增加(P0.05),而RS組與SP組之間則差異無統(tǒng)計(jì)學(xué)意義(P0.05)。T3、T4較T1、T2、T5時間點(diǎn),各組r Sc O2均有明顯下降(P0.05)。各組之間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。與RP組、RS組比較,SP組BIS值明顯下降(P0.05),而N組BIS值則明顯上升(P0.05),同時N組在SSFQ評分上較其余三組也呈明顯升高(P0.05)。結(jié)論:與使用硝酸甘油進(jìn)行CH相比,在顱腦手術(shù)中,使用瑞芬太尼、七氟烷、丙泊酚三種麻醉藥物兩兩聯(lián)合實(shí)施CH,即可以在保證患者安全的前提下,減少術(shù)野出血滿足手術(shù)需求,同時也可以減低腦組織中MDA的含量,增加SOD的活性,發(fā)揮腦保護(hù)的作用。相較于丙泊酚聯(lián)合瑞芬太尼或七氟烷兩組CH方案,瑞芬太尼聯(lián)合七氟烷對腦脂質(zhì)過氧化損傷的減輕程度更加明顯,且不會加大麻醉深度,是一種安全可靠的CH方案,可以應(yīng)用于臨床顱腦手術(shù)當(dāng)中。
[Abstract]:Aim: to investigate the effect of controlled hypotension between different anesthetic drugs on brain lipid peroxidation injury in patients undergoing craniocerebral surgery. Methods: 120 patients with glioma underwent selective craniotomy under general anesthesia (confirmed by pathological section after operation) were selected. All patients were randomly divided into four groups: remifentanil sevoflurane (RS) group, remifentanil propofol (RP) group, sevoflurane propofol (SP) group and nitroglycerin (N) group. The mean arterial pressure (map) of all patients was decreased by 30% of the preoperative baseline value within 10 minutes. The surgeon closed the dura mater and stopped the administration of CH3. Mean arterial pressure (map), heart rate (HR) and regional cerebral oxygen saturation (r SC O 2) were continuously monitored in all patients before induction of general anesthesia (T1), and 30 minutes after Ch began (T 4) 30 minutes after Ch began with scalp retractor fixation (T 2). The clock (T 5) is recorded at five points in time. At the same time, the 3ml of internal jugular vein and radial artery were collected from five time points to vacuum tube, and then placed in the refrigerator at -80 鈩，

本文編號：2092229