張瑋

[摘要] 目的 探討不同麻醉方式對重型顱腦損傷急診手術(shù)患者的影響。 方法 收集2014年1月～2017年1月期間我院急診科收治的重型顱腦損傷患者共60例作為研究對象，將其按照不同的麻醉方法分為兩組，對照組和觀察組各30例，兩組均給予相同的術(shù)前準(zhǔn)備，對照組靜吸復(fù)合麻醉，觀察組全憑靜脈麻醉，比較兩組插管前、插管后10 min、插管后1 h、手術(shù)結(jié)束HR、SBP、DBP，并發(fā)癥情況、致殘及死亡情況。 結(jié)果 觀察組插管前、插管后10 min、插管后1 h、手術(shù)結(jié)束后HR、SBP、DBP與對照組比較，差異無統(tǒng)計學(xué)意義（P>0.05），觀察組呼吸衰竭發(fā)生率、并發(fā)癥總發(fā)生率、致殘率、死亡率均低于對照組，兩組差異有統(tǒng)計學(xué)意義（P<0.05）。 結(jié)論 重型顱腦損傷急診手術(shù)患者使用全憑靜脈麻醉效果更好，不會對患者形成明顯的影響，且并發(fā)癥發(fā)生率、死亡率及致殘率均較低，可在臨床推廣應(yīng)用。

[關(guān)鍵詞] 顱腦損傷；麻醉；急診；靜吸復(fù)合麻醉；全憑靜脈麻醉

[中圖分類號] R614；R651.1+5 [文獻(xiàn)標(biāo)識碼] B [文章編號] 1673-9701（2017）13-0122-03

[Abstract] Objective To investigate the effect of different anesthesia methods on the emergency surgery in the patients with severe craniocerebral injury. Methods A total of 60 patients with severe craniocerebral injury who were admitted to the emergency department in our hospital from January 2014 to January 2017 were collected as the study subjects. The patients were divided into two groups according to different anesthesia methods， with 30 cases each in the control group and the observation group. Both groups were given the same preoperative preparation. The control group was given intravenous inhalational anesthesia. The observation group was given total intravenous anesthesia. HR， SBP， DBP， complications， disability and death before intubation， 10 min after intubation， 1 h after intubation and at the end of surgery were compared between the two groups. Results There were no statistically significant differences in HR， SBP and DBP between the observation group and the control group before intubation， 10 min after intubation， 1 h after intubation and at the end of surgery（P>0.05）. The incidence rate of respiratory failure， total incidence rate of complications， morbidity rate and mortality rate in the observation group were lower than those in the control group， and there were statistically significant differences between the two groups（P<0.05）. Conclusion Total intravenous anesthesia in the emergency surgery in the patients with severe craniocerebral has a better effect， which does not have a significant impact on the patients， and the incidence rate of complications， mortality rate and morbidity rate are low， which can be popularized and applied clinically.

[Key words] Craniocerebral injury；Anesthesia；Emergency；Intravenous inhalational anesthesia； Total intravenous anesthesia

顱腦損傷是指暴力作用于頭部引起的腦組織損傷，多由銳器傷、交通事故及墜跌傷等導(dǎo)致，重型顱腦損傷是指顱腦損傷患者傷后昏迷時間超過6 h 或再次昏迷者，是臨床中比較嚴(yán)重的急危癥，患者以意識障礙、頭暈、惡心、失語等為主要的臨床表現(xiàn)[1]，病情危重緊急，需要及時救治，否則可能會導(dǎo)致患者死亡或殘疾。重型顱腦損傷患者受傷程度不同，其病情也會發(fā)生相應(yīng)的變化，臨床多開顱手術(shù)治療，在急診手術(shù)中，為了使患者的疼痛舒緩、確保手術(shù)順利進(jìn)行，麻醉的實施是非常重要的環(huán)節(jié)，手術(shù)的成功率及手術(shù)后并發(fā)癥發(fā)生率會受到麻醉方法及麻醉劑量的直接影響[2-3]。本文對60例重型顱腦損傷急診手術(shù)患者進(jìn)行分析，根據(jù)不同的麻醉方式分組，比較不同麻醉方式對患者的影響，現(xiàn)報道如下。