CAJ | 학술논문

目的观测神经外科手术中坐位全身麻醉对体循环血流动力学及全身氧代射的影响。方法 28例后颅窝及后颈髓手术病人，采用静脉复合诱导、吸入七氟醚或安氟醚及伍用芬太尼维持麻醉，以Swan-Ganz导管、动脉和混合静脉血气监测及Fick方法测定血流动力学和氧代谢参数，包括CI、RAP、PCWP、SVRI、pHa、PaCO2、PvCO2、PaO2、SvO2、Hct、T、DO2、及VO2等。分别在麻醉前、坐位前、坐位后、坐位60分钟、坐位120分钟及术毕平卧位等时间点进行测定。结果麻醉诱导后及坐位手术期间CI一直呈降低并维持在正常值的低限（P＜0.001），RAP略增加，MAP略下降，而SVRI呈持续增高（P＜0.001）。此期间DO２和VO２显著减少（P＜0.05～0.001），但PaCO2、PvCO2、pHa、及HCO3－等参数均未见明显改变。术毕平卧后虽然CI、SVRI、T、Hct、DO2、VO2及PaCO2等恢复或维持至麻醉前水平，但pHa和BE-B呈有意义的下降、PvCO2呈有意义的增高（P＜0.05）。结论神经外科病人在坐位全麻手术期间只要维持血流动力学平稳，机体全身氧代谢可得到维持，但在麻醉苏醒期有易发生氧代谢异常的倾向。
목적 관측신경외과수술중좌위전신마취대체순배혈류동역학급전신양대사적영향。방법 28례후로와급후경수수술병인，채용정맥복합유도、흡입칠불미혹안불미급오용분태니유지마취，이Swan-Ganz도관、동맥화혼합정맥혈기감측급Fick방법측정혈류동역학화양대사삼수，포괄CI、RAP、PCWP、SVRI、pHa、PaCO2、PvCO2、PaO2、SvO2、Hct、T、DO2、급VO2등。분별재마취전、좌위전、좌위후、좌위60분종、좌위120분종급술필평와위등시간점진행측정。결과 마취유도후급좌위수술기간CI일직정강저병유지재정상치적저한（P＜0.001），RAP략증가，MAP략하강，이SVRI정지속증고（P＜0.001）。차기간DO２화VO２현저감소（P＜0.05～0.001），단PaCO2、PvCO2、pHa、급HCO3－등삼수균미견명현개변。술필평와후수연CI、SVRI、T、Hct、DO2、VO2급PaCO2등회복혹유지지마취전수평，단pHa화BE-B정유의의적하강、PvCO2정유의의적증고（P＜0.05）。결론 신경외과병인재좌위전마수술기간지요유지혈류동역학평은，궤체전신양대사가득도유지，단재마취소성기유역발생양대사이상적경향。
Objective To study the effects of sitting position on systemichemodynamics and oxygen metabolism during anesthesia and neurosurgery．Methods 28 patients scheduled for posterior fossa and posterior cervical spinal surgery were anesthetized with sevoflurane-fentanyl-pancuronium or enflurane-fentanyl-pancuronium．Swan-Ganz catheter technique and arterial and mixture venous blood gas analysis were used to obtain hemodynamics and blood gas data and Fick equation were used to calculate DO2 and VO2．The detection time points were as follows：before anesthesia induction，before sitting position， after sitting position，at sitting 60min，sitting 120min and at the supine position after completion of surgery．Results After induction of anesthesia and during operation in sitting position，CI decreased under the preanesthesia value （P＜0.001） with RAP increasing and MAP decreasing slightly，and SVRI raising persistently．DO2 and VO2 were significanly decreased （P＜0.05～0.001），but no marked changes in PaCO2，PvCO2，pHa and HCO3－ were found during the period．At the supine position after surgery，CI，SVRI，T，Hct，DO2，VO2 and PaCO2 were returned or maintained at the preanesthesia values．However，pHa，pHv and BEb decreased and PvCO2 increased significantly （P＜0.05）．Conclusion During neurosurgical procedure under general anesthesia with sitting position，global oxygen delivery and consumption can be kept well as long as the hemodynamics are properly maintained．Tissue oxygenation and metabolism may tend to imbalance during the postanesthetic recovery period．