不同麻醉方法对神经外科手术患者脑血管自身调节功能影响的比较

Objective To compare the effect of different methods of anesthesia on cerebral autoregulation in patients undergoing neurosurgery.Methods Sixty-nine ASA Ⅱ orⅢ patients with brain tumor, aged 23-62 yr, scheduled for neurosurgery under general anesthesia, were randomly divided into 3 groups ( n = 23 each) : propofol-remifentanil group (group PR), sevoflurane-remifentanil group (group SR) and propofol-sevoflurane-remifentanil group (group PSR) . Anesthesia was induced with target-controlled infusion (TCI) of propofol (target plasma concentration3 μg/ml, PR and PSR groups) or inhalation of 8% sevoflurane (group SR) and iv injection of remifentanil 1 mg/kg and atracurium 0.5 mg/kg. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 32-35 mm Hg. Anesthesia was maintained with TCI of propofol (target plasma concentration 2.0-3.5 μg/ml) in group PR, with inhalation of 1.5%-2.5% sevoflurane in group SR, with TCI of propofol (target plasma concentration 1.5-3.0 μg/ml) and inhalation of 1% sevoflurane in group PSR, and with TCI of remifentanil (target plasma concentration 2.0-4.5 ng/ml) and iv infusion of atracurium at 6 μg · kg-1 · min-1 in all groups. Auditory evoked potential index was maintained between 40-45. The middle cerebral artery time-average peak flow velocity was recorded before induction (baseline) , immediately after intubation, immediately before craniotomy and at the beginning of skin suture. The unilateral carotid artery was compressed for 7 s at the corresponding time points mentioned above. The transient hyperemic response ratio (THRR) was calculated to reflect cerebral autoregulation. Results Compared with the baseline value at T0, THRR was significantly increased at T2in group PR and decreased at T2,3 in group SR (P <0.05) ,while no significant change was found in THRR at T1-3in group PSR (P >0.05). The THRR was significantly lower in SR and PSR groups than in group PR, and higher in group PSR than in group SR ( P < 0.05). Conclusion Propofol-remifentanil anesthesia can improve cerebral autoregulation, sevoflurane-remifentanil anesthesia can reduce cerebral autoregulation, and propofol-sevofluraneremifentanil anesthesia exerts no effect on cerebral autoregulation in patients undergoing neurosurgery.     

不同麻醉方法对神经外科手术患者脑血管自身调节功能影响的比较

Objective To compare the effect of different methods of anesthesia on cerebral autoregulation in patients undergoing neurosurgery.Methods Sixty-nine ASA Ⅱ orⅢ patients with brain tumor, aged 23-62 yr, scheduled for neurosurgery under general anesthesia, were randomly divided into 3 groups ( n = 23 each) : propofol-remifentanil group (group PR), sevoflurane-remifentanil group (group SR) and propofol-sevoflurane-remifentanil group (group PSR) . Anesthesia was induced with target-controlled infusion (TCI) of propofol (target plasma concentration3 μg/ml, PR and PSR groups) or inhalation of 8% sevoflurane (group SR) and iv injection of remifentanil 1 mg/kg and atracurium 0.5 mg/kg. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 32-35 mm Hg. Anesthesia was maintained with TCI of propofol (target plasma concentration 2.0-3.5 μg/ml) in group PR, with inhalation of 1.5%-2.5% sevoflurane in group SR, with TCI of propofol (target plasma concentration 1.5-3.0 μg/ml) and inhalation of 1% sevoflurane in group PSR, and with TCI of remifentanil (target plasma concentration 2.0-4.5 ng/ml) and iv infusion of atracurium at 6 μg · kg-1 · min-1 in all groups. Auditory evoked potential index was maintained between 40-45. The middle cerebral artery time-average peak flow velocity was recorded before induction (baseline) , immediately after intubation, immediately before craniotomy and at the beginning of skin suture. The unilateral carotid artery was compressed for 7 s at the corresponding time points mentioned above. The transient hyperemic response ratio (THRR) was calculated to reflect cerebral autoregulation. Results Compared with the baseline value at T0, THRR was significantly increased at T2in group PR and decreased at T2,3 in group SR (P <0.05) ,while no significant change was found in THRR at T1-3in group PSR (P >0.05). The THRR was significantly lower in SR and PSR groups than in group PR, and higher in group PSR than in group SR ( P < 0.05). Conclusion Propofol-remifentanil anesthesia can improve cerebral autoregulation, sevoflurane-remifentanil anesthesia can reduce cerebral autoregulation, and propofol-sevofluraneremifentanil anesthesia exerts no effect on cerebral autoregulation in patients undergoing neurosurgery.     

七氟醚对神经外科手术患者颅内压的影响

目的 :观察静吸复合麻醉下 0 5、1 0MAC七氟醚对颅内压的影响。方法 :选颅内顺应性正常的择期行垂体瘤或颅咽管瘤手术患者 16例 ,随机分为两组 :A组用咪唑安定 +芬太尼 + 0 5MAC七氟醚 ;B组咪唑安定 +芬太尼+ 1 0MAC七氟醚。于L3～ 4穿刺至蛛网膜下腔以监测腰部脑脊液压 (ISP)。麻醉诱导采用芬太尼 咪唑安定 阿曲库铵。气管内插管后静脉泵入咪唑安定 0 1mg·kg-1·h-1、阿曲库铵 0 5mg·kg-1·h-1。插管后稳定 3 0分钟开始吸入七氟醚。分别于麻醉诱导前、吸入七氟醚前、达预定呼气末七氟醚浓度即刻、5、10、15、2 0、3 0分钟时观察并记录各监测指标。结果 :吸入 0 5MAC七氟醚后颅内压逐渐上升 ,达预定浓度后 3 0分钟上升 11 2 % ;吸入 1 0MAC七氟醚后颅内压首先呈显著性下降 ,15分钟后逐渐回复至基础水平。结论 :0 5、1 0MAC七氟醚可安全用于神经外科颅内顺应性正常的患者。     

七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者脑血流量和颅内压的比较

目的 比较七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者的脑血流量(CBF)和颅内压(ICP).方法 择期拟行妇科腹腔镜手术患者40例,年龄20～59岁,体重44～69kg,ASA Ⅰ或Ⅱ级,随机分为2组(n=20):七氟醚复合麻醉组(S组)和异丙酚复合麻醉组(P组).麻醉诱导:S组吸人8%七氟醚,P组TCI异丙酚(Ce 4μg/ml),两组均TCI瑞芬太尼(Ce 6ng/ml),睫毛反射消失后,静脉注射顺阿曲库铵0.15mg/kg,BIS<45时行气管插管.麻醉诱导后瑞芬太尼Ce下调为3 ng/ml,调节异丙酚Ce和七氟醚吸人浓度,维持BIS 45～50,于麻醉诱导前水平仰卧位稳定后5 min(T1)、水平截石位稳定后5 min(T2)、气管插管后即刻(T3)、气管插管后5 min(T4)、气腹头低位后即刻(T5)、气腹头低位后15 min(T6)及气腹放气后10 min(T7)时采用经颅多普勒超声测定大脑中动脉脑血流速率(CBFV)和搏动指数(PI).结果 与T1时比较,P组T3,4,7时CBFV降低,T3,4时P1降低,S组T4,7时CBFV降低,两组T5,6时PI升高(P<0.05);与T4时比较,两组T5,6时CBFV升高(P<0.05);与S组比较,P组T3时CBFV降低,T3,4时PI降低(P<0.05).结论 与七氟醚复合麻醉相比,异丙酚复合麻醉下妇科腹腔镜手术患者麻醉诱导后CBF和ICP明显降低;气腹后CBF和ICP均升高.     

七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者脑血流量和颅内压的比较

Objective To compare the cerebral blood flow (CBF) and intracranial pressure (ICP) during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia.Methods Forty ASAⅠ orⅡ patients aged 20-59 yr weighing 44-69 kg were randomly divided into 2 groups(n=20 each):propofol group (group P) and sevoflurane group (group S).Anesthesia was induced with TCI of propofol (Ce 4μg/ml) in group P or 8% sevoflurane in group S combined with TCI of remifentanil (Ce 6 ng/ml).Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of propofol or sevoflurane.inhalation combined with TCI of remifentanil.BIS value was maintained at 45-50 by adjusting Ce of propofol or concentration of sevoflurane.Intraabdominal pressure (IAP) was maintained at 12-14 mm Hg.Transcranial Doppler monitoring wag used.Cerebral blood flow velocity (CBFV) and pulsatility index (PI) were recorded at 5 min after supine position(T1)and 5 min after supine lithotomy position before induction(T2),while tracheal tube was being inserted(T3),5 min after tracheal intubation(T4),immediately and 15 min after abdominal CO2 iusnfflation in trendelenburglithotomy position (T5,T6) and at 10 min after deflation of abdomen(T7).Results CBFV was significandy decreased at T3,T4 and T7 in group P and at T4 and T7 in group S as compared with the baseline at T1.CBFV at T3 was significantly lower in group P than in group S.PI at T3,T4 was significantly decreased in group P as compared with the baseline at T1 and was significantly lower than in group S.PI at T5,6 was significantly increased as compared with the baseline in both groups but was not significantly different between the 2 groups.Conclusion When combined with remifentanil.propofol could decrease CBF and ICP while sevoflurane has no significant effect on CBF and ICP after induction.CBF and ICP are significantly increased in both groups after abdominal CO2 insufflation.     

七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者脑血流量和颅内压的比较

Objective To compare the cerebral blood flow (CBF) and intracranial pressure (ICP) during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia.Methods Forty ASAⅠ orⅡ patients aged 20-59 yr weighing 44-69 kg were randomly divided into 2 groups(n=20 each):propofol group (group P) and sevoflurane group (group S).Anesthesia was induced with TCI of propofol (Ce 4μg/ml) in group P or 8% sevoflurane in group S combined with TCI of remifentanil (Ce 6 ng/ml).Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of propofol or sevoflurane.inhalation combined with TCI of remifentanil.BIS value was maintained at 45-50 by adjusting Ce of propofol or concentration of sevoflurane.Intraabdominal pressure (IAP) was maintained at 12-14 mm Hg.Transcranial Doppler monitoring wag used.Cerebral blood flow velocity (CBFV) and pulsatility index (PI) were recorded at 5 min after supine position(T1)and 5 min after supine lithotomy position before induction(T2),while tracheal tube was being inserted(T3),5 min after tracheal intubation(T4),immediately and 15 min after abdominal CO2 iusnfflation in trendelenburglithotomy position (T5,T6) and at 10 min after deflation of abdomen(T7).Results CBFV was significandy decreased at T3,T4 and T7 in group P and at T4 and T7 in group S as compared with the baseline at T1.CBFV at T3 was significantly lower in group P than in group S.PI at T3,T4 was significantly decreased in group P as compared with the baseline at T1 and was significantly lower than in group S.PI at T5,6 was significantly increased as compared with the baseline in both groups but was not significantly different between the 2 groups.Conclusion When combined with remifentanil.propofol could decrease CBF and ICP while sevoflurane has no significant effect on CBF and ICP after induction.CBF and ICP are significantly increased in both groups after abdominal CO2 insufflation.     

七氟醚和地氟醚紧闭循环麻醉下神经外科手术后病人肾功能的变化

目的 比较七氟醚、地氟醚紧闭循环麻醉下神经外科手术后病人肾功能的变化，评价七氟醚紧闭循环麻醉应用于临床的安全性。方法 36例拟行神经外科手术病人，随机分为2组：七氟醚组（S组）和地氟醚组（D组），每组18例，新鲜气流量1-5L／min洗入2-3 min，之后降低至0．18～0．30L／min，七氟醚、地氟醚呼气末浓度分别维持在2．7％-4．0％、6．0％～10．0％。监测呼吸环路内氟甲基二氟乙烯醚（Compound A）浓度及吸入氧浓度。测定术前、术毕和术后2、24、72h血清氟离子（F^-）、肌酐（Cr）和尿素氮（BUN）浓度，测定术前、术毕和术后24、48、72h尿中总蛋白（TP）、β2微球蛋白（β2-MG）和β-N-乙酰氨基葡萄糖苷酶（NAG）水平。结果 在整个麻醉过程中病人吸入氧浓度不低于75％。术后两组血清Cr、BUN浓度及尿NAG／Cr与术前比较差异无统计学意义，组间比较差异无统计学意义。术后两组尿TP／Cr、β2-MG／Cr升高（P〈0．05），组间比较差异无统计学意义。TP／Cr、β2-MG／Cr与Compound A暴露量之间的相关系数分别为0．02、0．12（P〉0．05）。结论 七氟醚紧闭循环麻醉对神经外科手术后病人肾功能无影响。     

不同麻醉下老年高血压患者围术期心肌损伤的比较

目的 比较不同麻醉下老年高血压患者围术期心肌损伤的程度,为老年高血压患者选择适宜的麻醉方法.方法 择期行胸外科手术的老年高血压患者36例,年龄64岁,ASA Ⅱ或Ⅲ级,高血压Ⅱ级,高血压危险程度为中、高危险组,随机分为七氟醚组(S组)、异氟醚组(Ⅰ组)和异丙酚组(P组),每组12例.插管成功后至术毕,S组和I组呼气末吸入麻醉药浓度分别为1.7%、1.2%;P组静脉靶控输注异丙酚,血浆靶浓度2～3μg/ml.分别于麻醉前、气管插管后、手术探查后、拔除气管导管后即刻记录心电图ST段水平.于麻醉前、手术开始1 h、术毕、术后3、6、12、24 h抽取上肢静脉血,采用ELISA法测定血浆心肌肌酸激酶同工酶(CK-MB)活性和心肌肌钙蛋白I(cTnI)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、可溶性细胞间粘附分子-1(sICAM-1)的浓度.结果 拔除气管导管后即刻P组ST段水平明显低于S组和I组(P<0.05);与麻醉前比较,手术开始至术毕24 h各组血浆CK-MB活性、cTnI、IL-6、CRP和slCAM-1浓度明显升高(P<0.05);S组和I组术后24 h血浆cTnI,IL-6、CRP和sICAM浓度明显低于P组(P<0.05).结论 采用七氟醚或异氟醚复合麻醉时较采用异丙酚复合麻醉时老年高血压患者心肌损伤程度轻,围术期的炎性反应减轻;老年高血压患者宜采用吸人麻醉.     

不同全麻对非心脏手术患者术后认知功能影响的比较

目的 比较不同全麻对非心脏手术患者术后认知功能的影响.方法 拟行非心脏手术患者1000例,年龄18～60岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为5组(n=200):异氟醚+异丙酚+芬太尼组(IPF组)、异氟醚+瑞芬太尼组(IR组)、七氟醚+异丙酚+芬太尼组(SPF组)、七氟醚+瑞芬太尼组(SR组)和异丙酚+瑞芬太尼组(PR组).麻醉维持:IPF组和SPF组分别吸入1.68%异氟醚或1.71%七氟醚,TCI异丙酚,血浆靶浓度2～5 μg/ml,间断静脉注射芬太尼;IR组、SR组和PR组分别吸入1.68%异氟醚或1.71%七氟醚或TCI异丙酚,血浆靶浓度2～5 μg/ml,TCI瑞芬太尼,血浆靶浓度2～6 ng/ml.选择同期住院的非手术患者200例作为对照组(C组).于术前1 d、出麻醉恢复室时、术后1和3 d时,采用MMSE量表进行认知功能评分.于出麻醉恢复室时、术后1和3 d时,采用Z计分法评判认知功能障碍.结果 与C组比较,IPF组、IR组、SPF组、SR组和PR组出麻醉恢复室时MMSE评分降低,出麻醉恢复室时及术后1 d时认知功能障碍的发生率升高(P＜0.05);与IPF组、IR组、SPF组和PR组比较,SR组术后认知功能障碍的发生率降低(P＜0.05).结论 七氟醚复合瑞芬太尼麻醉对非心脏手术患者术后认知功能的影响较小.

Abstract：

Objective To compare the effects of methods of general anesthesia on postoperative cognitive function in patients undergoing non-cardiac surgery. Methods One thousand ASA Ⅰ or Ⅱ patients, aged 18-60 yr, undergoing non-cardiac surgery were randomly divided into 5 groups ( n = 200 each) : isoflurane + propofol + fentanyl group (group IPF); isoflurane + remifentanil group (group IR) ; sevoflurane + propofol + fentanyl group (group SPF) ; sevoflurane + remifentanil group (group SR) ; propofol + remifentanil group (group PR) . Two hundred non-operative patients served as control group (group C) . In groups IPF and SPF, anesthesia was maintained with inhalation of 1.68% isoflurane or 1.71 % sevoflurane, TCI of propofol with the target plasma concentration of 2-5 μg/ml, and intermittent iv boluses of fentanyl. In groups IR, SR and PR, anesthesia was maintained with inhalation of 1.68% isoflurane or 1.71% sevoflurane, or TCI of propofol with the target plasma concentration of 2- 5 μg/ml, and TCI of remifentanil with the target plasma concentration of 2-6 ng/ml. The patients' cognitive function was assessed using mini-mental state examination (MMSE) at 1 d before operation, while leaving postanesthesia care unit (PACU) , and at 1 and 3 d after operation. The Z score was used to identify the cognitive dysfunction as recommended by Moller while leaving PACU, and at 1 and 3 d after operation. Results Compared with group C, the MMSE score was significantly decreased while leaving PACU , and the incidence of cognitive dysfunction increased while leaving PACU and at 1 d after operation in the other groups ( P ＜ 0.05). Compared with groups IPF,IR,SPF and PR, the incidence of cognitive dysfunction was significantly increased in group SR ( P ＜ 0.05) . Conclusion General anesthesia with sevoflurane combined remifentanil exerts less effect on the postoperative cognitive function in patients undergoing non-cardiac surgery.     

右美托咪定对丙泊酚复合瑞芬太尼麻醉下脑功能区手术患者唤醒试验质量的影响

目的 评价右美托咪定对丙泊酚复合瑞芬太尼麻醉下脑功能区手术患者唤醒试验质量的影响.方法 拟行术中唤醒的脑功能区手术患者27例,性别不限,年龄17 ～ 43岁,BMI 20～ 24kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为2组∶对照组(C组,n=13)和右美托咪定组(D组,n=14).麻醉诱导后气管插管,麻醉维持:2组均靶控输注丙泊酚和瑞芬太尼,丙泊酚血浆靶浓度3 ～5 μg/ml,调整丙泊酚血浆靶浓度维持BIS值55 ～ 65,瑞芬太尼效应室靶浓度2～6ng/ml.打开硬脑膜后,D组停止输注丙泊酚和瑞芬太尼,经15 min静脉输注右美托咪定负荷量0.3μg/kg,随后以0.2 μg-1·kg·h-1速率维持;C组打开硬脑膜后15 min将丙泊酚血浆靶浓度降至0.5μg/ml,将瑞芬太尼效应室靶浓度降至0.5 ng/ml.记录唤醒时间、唤醒试验期间心血管事件、头痛、躁动、谵妄和术中知晓等的发生情况.结果 所有患者均成功实施唤醒,并顺利完成手术.与C组比较,D组唤醒试验期间高血压、心动过速、头痛和术中知晓的发生率均降低(P＜0.05),唤醒时间差异无统计学意义(P＞0.05),2组未见躁动和谵妄的发生.结论 右美托咪定可提高丙泊酚复合瑞芬太尼麻醉下脑功能区手术患者唤醒试验的质量.     

神经外科手术患者复合异丙酚时舒芬太尼的量效关系

目的通过观察电刺激-循环反应的变化,探讨神经外科手术患者复合异丙酚时舒芬太尼的量效关系。方法择期额颞部开颅手术患者15例,ASAⅠ或Ⅱ级,先行靶控输注异丙酚,设定效应室靶浓度为3μg/ml,必要时面罩辅助通气,维持患者呼气末二氧化碳分压为35～45 mm Hg,待达到异丙酚靶浓度后开始靶控输注舒芬太尼,设定效应室靶浓度分别为0.2、0.4、0.6、0.8、1.0、1.2、1.4、1.6 ng/ml,分别于舒芬太尼达不同效应室浓度时给予50mA、50Hz、5s强直电刺激,记录电刺激前后的BP、HR及脑电双频谱指数(BIS)。结果随着舒芬太尼效应室浓度的增加,BP、HR逐渐降低,电刺激-循环反应也逐渐减弱(P<0.05或0.01)。舒芬太尼效应室浓度达(0.56±0.15)ng/ml时,电刺激后MAP升高幅度<5%,95%可信区间为(0.27～0.85)ng/ml。舒芬太尼效应室浓度≥1.0 ng/ml时BIS降低(P<0.05或0.01);电刺激前后BIS差异无统计学意义(P>0.05)。结论随舒芬太尼效应室浓度的增加,电刺激-循环反应逐渐减弱;当出现封顶效应时,舒芬太尼效应室浓度为(0.56±0.15)ng/ml,95%可信区间为0.27～0.85 ng/ml。     

异丙酚、地氟醚或七氟醚复合瑞芬太尼麻醉对脑功能区手术患者术中唤醒试验的影响

目的 探讨异丙酚、地氟醚或七氟醚复合瑞芬太尼麻醉对脑功能区手术患者术中唤醒试验的影响.方法 择期拟行脑功能区肿瘤切除术患者60例,ASA Ⅰ或Ⅱ级,年龄18～60岁,随机分为3组:异丙酚组(P组)、地氟醚组(D组)及七氟醚组(S组),每组20例.静脉注射依托咪酯0.3mg/kg、芬太尼3 μg/kg、维库溴铵0.1 mg/kg行麻醉诱导,采用1%丁卡因喉头及气管粘膜表面麻醉后行气管插管.P组、D组和S组分别靶控输注异丙酚,血浆靶浓度2.0μg/ml,持续吸入地氟醚、七氟醚1.5 MAC维持麻醉.各组均靶控输注瑞芬太尼,血浆靶浓度2.5 ng/ml,唤醒试验前血浆靶浓度降为0.5 ng/ml,静脉注射曲马多100mg,停用麻醉药,行唤醒试验.记录唤醒时间,观察唤醒试验时躁动及寒颤的发生情况.结果 各组患者唤醒时间差异无统计学意义(P>0.05),P组寒颤发生率较D组和S组高(P<0.05).结论 采用异丙酚、地氟醚或七氟醚复合瑞芬太尼麻醉,脑功能区手术患者术中唤醒时间无差别,地氟醚或七氟醚复合瑞芬太尼麻醉时有关并发症发生率低,更适用于术中唤醒试验.     

复合异丙酚时不同靶浓度瑞芬太尼对神经外科手术患者脑电双频谱指数的影响

目的 探讨复合异丙酚时不同效应室靶浓度瑞芬太尼对神经外科手术患者脑电双频谱指数(BIS)的影响.方法 择期拟行额颞部开颅手术患者15例,年龄18～64岁,体重50～85 kg,ASA Ⅰ或Ⅱ级.先靶控输注异丙酚,效应室靶浓度为3μg/ml,效应室浓度达预设浓度后靶控输注瑞芬太尼,效应室靶浓度分别为2、3、4、5、6、7、8 ng/ml,效应室浓度依次达预设浓度时记录血压(BP)、平均动脉压(MAP)、心率(HR)和BIS.瑞芬太尼效应室浓度达5 ng/ml时行气管插管和机械通气,于气管插管前即刻和气管插管后即刻记录BP、MAP、HR和BIS.结果 与基础值比较,异丙酚效应室浓度3μG/ml 和瑞芬太尼不同效应室浓度时BIS降低(P<0.05或0.01);与异丙酚效应室浓度3μg/ml时比较,瑞芬太尼效应室浓度≥6 nG/Ml时BIS降低(P<0.05或0.01).结论 复合异丙酚时靶控输注瑞芬太尼效应室浓度≥6 ng/ml时可降低神经外科手术患者的BIS.     

单纯七氟醚吸入麻醉与异丙酚-舒芬太尼静脉麻醉用于妇科日间手术患者效果的比较

目的 比较单纯七氟醚吸入麻醉与异丙酚-舒芬太尼静脉麻醉用于妇科日间手术患者的效果.方法 拟行门 诊人上流产术患者140例,年龄18～35岁,体重45～ 65kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为2组(n=70):异丙酚-舒芬太尼静脉麻醉组(Ⅰ组)和单纯七氟醚吸入麻醉组(Ⅱ组).Ⅰ组静脉注射舒芬太尼0.2μg/kg,静脉输注1％异丙酚2～3mg· kg -1·min-1,睫毛反射消失后,以3～4 mg·kg-1·h-1的速率静脉输注.Ⅱ组面罩吸入8％七氟醚,氧流量6 L/min,待睫毛反射消失后,将氧流量调至3 L/min,七氟醚挥发罐划度调至2％～3％.记录麻醉诱导时间、苏醒时间、手术时间、术中低氧血症发生情况、体动情况及相关不良事件发生情况.结果 与Ⅰ组比较,Ⅱ组麻醉诱导时间延长,苏醒期躁动、恶心、呕吐发生率升高,性幻觉发生率降低(P＜0.05),手术时间、苏醒时间、寒战、低氧血症发生率和体动反应分级比较差异无统计学意义(P＞0.05).结论 与单纯七氟醚吸入麻醉相比,异丙酚-舒芬太尼静脉麻醉更适用于妇科日间手术患者,有利于改善患者麻醉恢复质量.     

颅脑手术病人呼气末二氧化碳分压与脑血流、脑代谢、颅内压相关性研究

目的 观察颅脑手术病人不同呼气末二氧化碳分压（PaCO2）与脑代谢、脑血流、颅内压的相关性。方法 12例择期行颅脑手术病人,行七氟醚麻醉,待1.3MAC时,调整呼吸频率,使PETCO2达40、30、20mm Hg,每阶段稳定 30min.分别采清醒时及PETCO2各时段的颈内静脉、桡动脉血以及脑脊液作血气分析以及测定葡萄糖、乳酸含量,根据血气分析找出相对应的PaCO2,用修正Kety-Schmidt惰性气体饱和技术计算CBF,并由此根据动静脉差值计算出CMRO2、CMRglu值的变化。结果 与清醒时通气状态相比,PET COZ 20Tin Hg脑血流减少57.75％。CMROZ减少58.70％,,CMRglu减少46.93％,（P<0.05）。颈静脉血氧饱和度以及pH无明显变化（P>0.05）。P。COZ 40和20mm Hg时脑血流比P。,CO 30mm Hg时增加和减少了29.2％和11.3％（P<0.05）,随着PETCO2的降低ICP也呈不同程度的下降（r=0.857,P<0.01）。不同PETCO2下脑脊液中PH、乳酸盐和SjvO2无明显变化（P>0.05）。结论 1.3MAC七氟醚麻醉下,不同PET CO2时神经外科手术病人CBF、CMR和 ICP与 PETCO2变化相关,表明脑血管对CO2的反应性依然存在,但由于PETCO2　40mmHg时CBF增加,所以临床上应予避免。