复旦学报（医学版）
複旦學報（醫學版）
복단학보（의학판）
FUDAN UNIVERSITY JOURNAL OF MEDICAL SCIENCES
2009年
6期
715-718
,共4页
异丙酚%七氟醚%腹腔镜%脑血流速率%经颅多普勒超声
異丙酚%七氟醚%腹腔鏡%腦血流速率%經顱多普勒超聲
이병분%칠불미%복강경%뇌혈류속솔%경로다보륵초성
propofol%sevoflurane%laparoscopy%cerebral blood flow velocity%transcranial Doppler ultrasonography
目的 研究妇科腹腔镜术中七氟醚或异丙酚联合瑞芬太尼对脑血流量(cerebral blood flow,CBF)和脑血管自身调节能力的影响.方法 择期行妇科腹腔镜手术患者40例,随机分为七氟醚组(S组,n=20)和异丙酚组(P组,n=20).两组分别采用七氟醚或异丙酚复合瑞芬太尼诱导和维持麻醉,在诱导前水平仰卧位(T_1)、水平截石位(T_2)、诱导插管后即刻(T_3)、诱导插管后5 min(T_4),气腹头低位后即刻(T_5)、气腹头低位后15 min(T_6)、气腹放气后10 min(T_7)观察各时间点的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、PaCO_2、P_(ET)CO_2、大脑中动脉时间平均峰值流速(time-average peak flow velocity,TAP)和脑短暂充血反应(transient hyperaemic response, THR).结果 与TI时点相比,P组TAP在T_2、T_5、T_6时点均无显著变化,而在T_3、T_4、T_7时点明显降低,S组仅在T_4、T_7时点明显下降,T_3时点明显高于P组,且与T_1时点无显著差异;S组THR反应率(THRR)在T_3时点与T_1时点相比显著下降,且低于P组.结论 联合瑞芬太尼麻醉诱导和维持时,异丙酚可降低CBF,但对脑血管自身调节能力无明显影响,而七氟醚在吸入高浓度时能明显降低脑血管自身调节能力;CO_2气腹与头低截石体位可显著升高CBF,其作用明显强于临床常用剂量的麻醉药物,但对脑血管自身调节能力无明显影响.
目的 研究婦科腹腔鏡術中七氟醚或異丙酚聯閤瑞芬太尼對腦血流量(cerebral blood flow,CBF)和腦血管自身調節能力的影響.方法 擇期行婦科腹腔鏡手術患者40例,隨機分為七氟醚組(S組,n=20)和異丙酚組(P組,n=20).兩組分彆採用七氟醚或異丙酚複閤瑞芬太尼誘導和維持痳醉,在誘導前水平仰臥位(T_1)、水平截石位(T_2)、誘導插管後即刻(T_3)、誘導插管後5 min(T_4),氣腹頭低位後即刻(T_5)、氣腹頭低位後15 min(T_6)、氣腹放氣後10 min(T_7)觀察各時間點的平均動脈壓(mean arterial pressure,MAP)、心率(heart rate,HR)、PaCO_2、P_(ET)CO_2、大腦中動脈時間平均峰值流速(time-average peak flow velocity,TAP)和腦短暫充血反應(transient hyperaemic response, THR).結果 與TI時點相比,P組TAP在T_2、T_5、T_6時點均無顯著變化,而在T_3、T_4、T_7時點明顯降低,S組僅在T_4、T_7時點明顯下降,T_3時點明顯高于P組,且與T_1時點無顯著差異;S組THR反應率(THRR)在T_3時點與T_1時點相比顯著下降,且低于P組.結論 聯閤瑞芬太尼痳醉誘導和維持時,異丙酚可降低CBF,但對腦血管自身調節能力無明顯影響,而七氟醚在吸入高濃度時能明顯降低腦血管自身調節能力;CO_2氣腹與頭低截石體位可顯著升高CBF,其作用明顯彊于臨床常用劑量的痳醉藥物,但對腦血管自身調節能力無明顯影響.
목적 연구부과복강경술중칠불미혹이병분연합서분태니대뇌혈류량(cerebral blood flow,CBF)화뇌혈관자신조절능력적영향.방법 택기행부과복강경수술환자40례,수궤분위칠불미조(S조,n=20)화이병분조(P조,n=20).량조분별채용칠불미혹이병분복합서분태니유도화유지마취,재유도전수평앙와위(T_1)、수평절석위(T_2)、유도삽관후즉각(T_3)、유도삽관후5 min(T_4),기복두저위후즉각(T_5)、기복두저위후15 min(T_6)、기복방기후10 min(T_7)관찰각시간점적평균동맥압(mean arterial pressure,MAP)、심솔(heart rate,HR)、PaCO_2、P_(ET)CO_2、대뇌중동맥시간평균봉치류속(time-average peak flow velocity,TAP)화뇌단잠충혈반응(transient hyperaemic response, THR).결과 여TI시점상비,P조TAP재T_2、T_5、T_6시점균무현저변화,이재T_3、T_4、T_7시점명현강저,S조부재T_4、T_7시점명현하강,T_3시점명현고우P조,차여T_1시점무현저차이;S조THR반응솔(THRR)재T_3시점여T_1시점상비현저하강,차저우P조.결론 연합서분태니마취유도화유지시,이병분가강저CBF,단대뇌혈관자신조절능력무명현영향,이칠불미재흡입고농도시능명현강저뇌혈관자신조절능력;CO_2기복여두저절석체위가현저승고CBF,기작용명현강우림상상용제량적마취약물,단대뇌혈관자신조절능력무명현영향.
Objective To observe the effects of propofol or sevoflurane combined with remifentanil on cerebral blood flow (CBF) and cerebral autoregulation in patients undergoing gynecologic laparoscopic surgery. Methods Forty patients were randomly divided into two groups: the propofol group (group P, n=20) and the sevoflurane group (group S, n=20). Anaesthesia was induced with target-controlled infusion (TCI) of propofol and remifentanil in group P, with an inhaled induction of sevoflurane and TCI of remifentanil in group S, respectively. The depth of anesthesia was regulated according to bispectral index (BIS). The pressure of end-tidal carbon dioxide (P_(ET)CO_2) was kept at 35-40 mmHg by mechanical ventilation. The mean arterial pressure (MAP), heart rate (HR), pressure of arterial carbon dioxide (PaCO_2), P_(ET)CO_2, time-averaged peak flow velocity (TAP) and the transient hyperaemic response ratio (THRR) were recorded at 7 different time points: supine position (T_1) and supine lithotomy position before induction (T_2), the instant and 5 min after tracheal intubation (T_3,T_4), the instant and 15 min after abdominal CO_2 insufflation and trendelenburg-lithotomy position (T_5,T_6), and 10 min after the deflation abdomen (T_7), respectively. Results Compared with the baseline values at T_1, TAP was not significantly changed at T_2, T_5, or T_6 in group P, but was markedly decreased at T_3, T_4 and T_7. TAP in group S only decreased at T_4 and T_7, while it was much higher than that in group P at T_3. In group S, THRR was markedly lowered at T_3 compared with that at T_1; but in group P, it showed a significant increase at T_3. Conclusions Combined with remifentanil, propofol decreased CBF, but has no effect on the brain self-regulation. When inhaled in high concentrations, sevoflurane significantly reduces the brain self-regulation. Intraoperation pneumoperitoneum and postural factor significantly increase CBF, playing a stronger role than the narcotic drugs in clinical dosage (propofol, sevoflurane), without any influence on the brain self-regulation.
