熊严全　戚靖羚　周航　余云湖

【摘要】 目的：探讨瑞芬太尼对颅内动脉瘤夹闭术患者血流动力学的影响。方法：回顾性分析2018年7月-2019年7月笔者所在医院收治的130例颅内动脉瘤患者临床资料，按照麻醉方式不同将其分为两组，各65例。两组均实施夹闭术治疗，对照组采用芬太尼麻醉，观察组采用瑞芬太尼麻醉。比较两组血流动力学指标、激素水平及并发症发生情况。结果：观察组切皮时（T2）、手术结束时（T3）时的心率（HR）、收缩压（SBP）、舒张压（DBP）、肾上腺素（AD）、去甲肾上腺素（NE）水平均低于对照组，血清皮质醇（FC）高于对照组，差异均有统计学意义（P<0.05）。两组并发症发生率比较，差异无统计学意义（P>0.05）。结论：瑞芬太尼在颅内动脉瘤夹闭术中具有较好的稳定、镇静作用，有助于血流动力学稳定，抑制插管应激激素反应，促进手术顺利进行。

【关键词】 颅内动脉瘤 夹闭术 瑞芬太尼 血流动力学

doi：10.14033/j.cnki.cfmr.2020.21.016 文献标识码 B 文章编号 1674-6805（2020）21-00-03

Effect of Remifentanil on Hemodynamics in Patients with Intracranial Aneurysm Clipping/XIONG Yanquan， QI Jingling， ZHOU Hang， YU Yunhu. //Chinese and Foreign Medical Research， 2020， 18（21）： -41

[Abstract] Objective： To investigate the effect of Remifentanil on hemodynamics in patients with intracranial aneurysm clipping. Method： The clinical data of 130 patients with intracranial aneurysm admitted in our hospital from July 2018 to July 2019 were retrospectively analyzed. According to different anesthesia methods， the patients were divided into two groups， with 65 cases in each group. Both groups were treated with clipping. The control group was anestheted with Fentanyl， and the observation group was anestheted with Remifentanil. The hemodynamic indexes， hormone levels and complications were compared between the two groups. Result： The levels of heart rate （HR）， systolic blood pressure （SBP）， diastolic blood pressure （DBP）， adrenaline （AD） and norepinephrine （NE） in the observation group were lower than those in the control group at the time of skin resection （T2） and the end of surgery （T3）， and the serum cortisol （FC） were higher than those in the control group， the differences were statistically significant （P<0.05）. There was no significant difference in the incidence of complications between the two groups （P>0.05）. Conclusion： Remifentanil has a good stability and sedation effect in intracranial aneurysm clamping， which is conducive to the stability of hemodynamics， inhibit intubation stress hormone response， and promote the smooth operation.

[Key words] Intracranial aneurysm Clipping Remifentanil Hemodynamics

First-authors address： Peoples Hospital in Honghuagang District of Zunyi， Zunyi 563000， China

顱内动脉瘤可导致蛛网膜下腔出血，该病的形成、发展及破裂均与患者血流动力学有密切关系[1-2]。夹闭术是常用治疗方法，其疗效佳，但会造成一定创伤，易引发动脉瘤破裂等并发症，而术中的各项操作也会对患者造成刺激，引起心率加快、血压及颅内压升高，也会影响手术效果[3]。因此，选择适合的麻醉药物，对维持术中血流动力学，促进患者康复具有重要意义。鉴于此，本研究选取了130例动脉瘤患者，进一步探讨瑞芬太尼对颅内动脉瘤夹闭术患者血流动力学的影响，现报道如下。

1 资料与方法

1.1 一般资料

回顾性分析2018年7月-2019年7月笔者所在医院收治的130例颅内动脉瘤患者的临床资料，纳入标准：（1）经CT及核磁共振成像确诊为颅内动脉瘤;（2）有恶心、头痛、抽搐、昏迷等症状。……