七氟醚复合丙泊酚控制性降压对脑氧代谢的影响.doc

颅脑手术中七氟醚复合丙泊酚控制性降压 对脑氧代谢的影响 吴磊 罗文杰 黄永 于益琪 钟妍 杭燕南 【摘要】目的 观察七氟醚复合丙泊酚用于颅脑手术麻醉的控制性降压技术对于脑氧代谢的影响。方法 随机选择ASA I-Ⅱ级择期颅脑手术病人30例，术中通过增加七氟醚呼气末浓度，使MAP较基础值下降30-40﹪，分别于麻醉前、降压前、降压30min、降压后4个时间点记录血液动力学指标数值、七氟醚浓度、异丙酚靶控浓度，同步采集桡动脉和颈内静脉血行血气分析，计算动静脉血氧含量差（Ca- jvO2）、脑氧代谢率（CERO2）及脑氧摄取率（OER）。结果 与降压前比较， 降压30min和降压后的pHa、aHCO3 、CaO2 、pHjv、jvHCO3均无明显变化(P0.05)，但降压30min后，PaO2 ,PjvO2 ,CjvO2较降压前有所增加，D(a-jv)O2 、CERO2、OER降压后呈降低趋势，降压后数值均能够回复到降压前水平。结论 采用异丙酚靶控浓度4.0 ug﹒ml-1与七氟醚呼气末浓度为（1.34±0.17）MAC行控制性降压易于实施和调节，可降低颅脑手术病人的脑氧代谢，血流动力学稳定，适合在神经外科手术中应用。 【关键词】七氟醚；丙泊酚；降压；控制性；脑；代谢 Effect of induced hypotension by propofol combined with sevoflurane on the cerebral metabolism of neurosurgical patients WU Lei, LUO Wenjie, HUANG Yong, YU Yiqi, ZHONG Yan, Department of Anesthesiology, People Hospital, Putuo, Shanghai 200060, China HANG Yannan Department of Anesthesiology, Renji Hospital, Shanghai Jiao-Tong University School of Medcine 200001, China 【Abstract】 Objective To determine the effect of induced hypotension by propofol combined with sevoflurane on the cerebral metabolism of neurosurgical patients. Methods Thirty ASA I-Ⅱpatients undergoing elective neurosurgery were enrolled into the study. The MAP was decreased to 30-40﹪ of baseline as the induced hypotension, MAP, HR,MAC of sevoflurane and propofol infusion rate were measured before surgery, before, 30 min during and 30min after the end of induced hypotension. Radial arterial blood samples and jugular blood vein samples were taken synchronously for measuring Ca- jvO2, CERO2, and OER. Results There were no significant changes in blood pHa,aHCO3 ,CaO2 ,pHjv,jvHCO3 during the period of induced hypotension. PaO2 ,PjvO2 and CjvO2 increased after induced hypotension for 30min. CERO2 and OER decreased after induced hypotension. Conclusion The results show that induced hypotension by propofol(TCI 4.0 ug﹒ml-1 ) combined with sevoflurane（1.34±0.17MAC）can reduce the cerebral metabolism and provide benefits for neurosurgical patients. 基金项目：上海市普陀区学科带头人培养对象基金资助课题(P