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目的探讨瑞芬太尼麻醉对颅内肿瘤手术患者的脑氧代谢、脑血流动力和炎性细胞因子的影响。方法选取2012年3月至2016年12月间山东省临朐县人民医院收治的50例拟行开颅肿瘤切除术的颅内肿瘤患者,根据麻醉用药的不同随机分为观察组与对照组,每组25例。观察组患者采用瑞芬太尼联合丙泊酚、罗库溴铵和七氟醚麻醉,对照组患者采用芬太尼联合丙泊酚、罗库溴铵和七氟醚麻醉。对比两组患者麻醉前和麻醉后20min脑血流动力学指标:阻力指数(RI)、收缩期血流速度(Vs)和舒张期血流速度(Vd),脑氧代谢指标:脑氧摄取率(CERO_2)、颈内静脉血氧含量(CjvO_2)和动脉-颈内静脉血氧含量差(Da-jvO_2)的变化,检测术前和术后18h超敏C反应蛋白(HsCRP)和肿瘤坏死因子-α(TNF-α)的表达水平。结果两组患者麻醉前,脑氧代谢指标、脑血流动力学指标及术前炎性细胞因子表达均无统计学意义。麻醉后20min,观察组患者Vs、Vd、CERO_2和CjvO_2均明显高于对照组,RI和Da-jvO_2显著低于对照组,差异均有统计学意义(均P<0.05)。术后18h,观察组患者Hs-CRP和TNF-α表达均明显低于对照组,差异均有统计学意义(均P<0.05)。结论瑞芬太尼在颅内肿瘤患者麻醉术中,不仅有利于脑氧代谢、脑血流的改善,还可降低炎性反应,安全性和临床效果更优。
Objective To investigate the effects of remifentanil anesthesia on cerebral oxygen metabolism, cerebral blood flow and inflammatory cytokines in patients undergoing intracranial tumor surgery. Methods From March 2012 to December 2016, 50 cases of intracranial tumors undergoing resection of craniotomy in Linli County People’s Hospital of Shandong Province were selected and randomly divided into observation group and control group according to different anesthetic drugs. Group of 25 cases. Patients in the observation group were treated with remifentanil combined with propofol, rocuronium and sevoflurane, and patients in the control group were anesthetized with fentanyl plus propofol, rocuronium and sevoflurane. The cerebral hemodynamic parameters were compared before anesthesia and 20 minutes after anesthesia in two groups: resistance index (RI), systolic blood flow velocity (Vs) and diastolic blood flow velocity (Vd), cerebral oxygen metabolism index (HsCRP) and tumor necrosis factor-α (TNF-α) in preoperation and postoperative 18h after treatment with CERO_2, CjvO_2 and Da-jvO_2 in arterial- -α (TNF-α) expression levels. Results Before anesthesia, there was no significant difference in cerebral oxygen metabolism index, cerebral hemodynamics index and preoperative inflammatory cytokine expression between the two groups. At 20 minutes after anesthesia, the Vs, Vd, CERO_2 and CjvO_2 in the observation group were significantly higher than those in the control group, RI and Da-jvO_2 were significantly lower than those in the control group (all P <0.05). 18h after operation, the expression of Hs-CRP and TNF-α in observation group were significantly lower than those in control group (all P <0.05). Conclusion Remifentanil in anesthesia in patients with intracranial tumors is not only conducive to the improvement of cerebral oxygen metabolism, cerebral blood flow, but also reduce the inflammatory response, safety and clinical effect is better.