摘要： 目的   观察全身麻醉药物舒芬太尼和芬太尼对中枢神经系统肿瘤切除术患者围手术期血流动力学、苏醒期恢复情况及机体应激反应的影响。方法   50 例择期行中枢神经系统肿瘤切除术患者，随机接受舒芬太尼和芬太尼全身麻醉，观察并记录麻醉诱导后、插管后1 min、头架固定时、切开皮肤、切开硬脑膜、关闭硬脑膜、恢复呼吸即刻和拔管即刻等不同观察时间点平均动脉压、心率、脉搏血氧饱和度等项指标的变化，测定麻醉诱导前后血糖和肾上腺素水平。结果   与基础值相比，两组患者在切开硬脑膜、恢复呼吸即刻和拔管即刻心率增加（均P < 0.05），麻醉诱导后、切开硬脑膜、关闭硬脑膜时平均动脉压下降（均P < 0.05），但芬太尼组患者在切开皮肤和拔管即刻均出现平均动脉压升高现象（P <0.05）。手术过程中不同观察时间点，芬太尼组患者平均动脉压和心率均高于舒芬太尼组（P < 0.05 或P < 0.01），舒芬太尼组患者自主呼吸恢复时间早、拔管时间短（均P < 0.05）。两组患者手术前、切开皮肤30 min、拔管即刻血糖和肾上腺素水平比较，差异无统计学意义（均P > 0.05）。结论   与芬太尼组比较，舒芬太尼组患者在不同麻醉时期血流动力学更稳定，气管插管时心血管反应更小；舒芬太尼和芬太尼对患者围手术期血糖和肾上腺素均无明显影响。

关键词: 舒芬太尼, 芬太尼, 麻醉, 全身, 神经外科手术, 血流动力学

Abstract: Objective To compare the effects of sufentanil and fentanyl as general anesthesia on hemodynamics, recovery profiles and the stress reaction at perioperative period in patients undergoing intracranial tumor resection. Methods A total of 50 patients scheduled were randomized to receive sufentanil (group S, n = 25) or fentanyl (group F, n = 25) as general anesthesia for intracranial tumor resection. Sufentanil was performed in group S by combination of intravenous propofol and sevoflurane anesthesia, while fentanyl plus propofol continuous intravenous infusion was used in group F followed by sevoflurane anesthesia. The patients' mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were continuously monitored and recorded at different time points including baseline (T0), postanesthesia induction (T1), 1 min after endotracheal intubation (T2), head holder application (T3), skin and dural incisions (T4, T5), dural closure (T6), spontaneous breath recovery (T7) and after endotracheal extubation (T8). Blood glucose and epinephrine were determined before and after anesthesia induction. Results In both groups, the HR at T5, T7 and T8 were higher than baseline value (P < 0.05, for all), and MAP decreased at T1, T5 and T6 (P < 0.05, for all). Increased MAP was seen in group F during T4 and T8 (P < 0.05, for all). MAP and HR were all higher in group F than those in group S during operation at different monitoring times (P < 0.05 or P < 0.01). Autonomous respiration recovery and endotracheal extubation were all earlier in group S than group F (P < 0.05, for all). There were no significant differences of blood glucose and epinephrine at preoperation, skin incision 30 min and extubation (P > 0.05, for all). Conclusion Compared to fentanyl, hemodynamics is more stable at different anesthetic periods, and cardiovascular reaction is more mild in endotracheal intubation by using sufentanil as anesthesia. Neither fentanyl nor sufentanil obviously effects blood glucose and epinephrine at perioperative period.

Key words: Sufentanil, Fentanyl, Anesthesia, general, Neurosurgical procedures, Hemodynamics