颈动脉内膜剥脱术中脑电双频指数与脑血流速度的相关性

目的探讨颈动脉内膜剥脱术(CEA)中脑电双频指数(BIS)和脑血流速度的相关性。方法择期CEA患者35例,年龄54~80岁。采用经颅多普勒(TCD)监测和记录入室时(T1)、麻醉诱导后气管插管前(T2)、游离颈动脉10min(T3)、阻断颈动脉5min(T4)、放置颈动脉转流管5min(T5)、开放颈动脉5min(T6)及60min(T7)时大脑左、右两侧脑血流峰值速度(Vp)、平均速度(Vm),以及相应时点的BIS值,分析相关性。结果 35例患者均采集BIS值,其中17例患者采集Vp、Vm。T2、T3、T4、T7时BIS与Vp、Vm呈显著正相关(P0.01);两侧Vp、Vm在T7时均呈显著正相关(r=0.542和r=0.649,P0.05)。T2时CEA侧BIS值与Vm呈显著正相关(r=0.498,P0.05);T1时非CEA侧BIS值与Vp呈显著正相关(r=0.556,P0.05)。T3、T4时CEA侧BIS值的变化与Vp的变化呈显著负相关(r=-0.584,P0.05),而非CEA侧无显著相关性。结论在CEA中,CEA侧与非CEA侧之间,其BIS值的变化因受到麻醉和脑血流量变化的双重影响而不完全一致。BIS值可反映脑血流速度的变化,在入手术室(非CEA侧)和麻醉诱导(CEA侧)时它们的变化方向一致,而在阻断颈动脉早期(CEA侧)的变化方向相反。     

神经外科手术中枕部与额部脑电双频指数相关性分析的研究

目的 分析神经外科手术中枕部与额部脑电双频指数(BIS)的相关性.方法 神经外科颅内肿瘤切除术患者10例,在同侧枕部和额部分别放置电极,取诱导前10min(T1)、切皮前10 min(T2),切皮后10min(T3),切开硬膜后10min(T4),切开硬膜后30～90min(T5)各时段BIS值进行分析.结果 枕部BIS值T1时明显低于额部(P<0.01),T2～T5时明显高于额部(P<0.01).麻醉前后枕部与额部BIS值具有正相关性(r2=0.954;P=0.000).结论 在神经外科手术中,麻醉前后枕部与额部BIS值有明显差异,但同时有良好的相关性.     

心率变异性Poincare散点图分析与BIS对麻醉深度监测的相关性研究

目的 观察全身麻醉时心率变异性分析中散点图分析和脑电双频指数(BIS)的变化,探讨散点图分析和BIS在监测麻醉深度时的相关性.方法 选择ASA Ⅰ或Ⅱ级择期手术患者28例,测定手术前一天(T1)、麻醉诱导前(T2)、诱导插管(T3)、手术开始1h(T4)、苏醒时(T5)、术后1d (T6)6个时点各5 min的HR、MAP、散点图的短轴(SD1)、长轴(SD2)的变化以及T2～T5时BIS变化.结果 与T1时比较,T6时MAP、SD2明显下降(P＜0.05).与T2时比较,T3时HR明显增快、MAP、SD2明显升高(P＜0.01);T4、T5时MAP、SD2明显下降(P＜0.05或P＜0.01);T3～T5时BIS、SD1明显下降(P＜0.01).结论 心率变异性非线性分析SD1能描述围术期心脏自主神经功能状态的变化,与反应麻醉镇静程度的BIS有很好的相关性.     

心率变异性近似熵分析法与脑电双频谱指数间的相关性

目的:观察全身麻醉时心率变异性分析中近似熵分析法与脑电双频谱指数(BIS)在监测麻醉深度时的相关性。方法:对40例全身麻醉病人测定麻醉前(T1)、诱导插管(T2)、术中(T3)、苏醒(T4)4个时间点各5min的心率(HR)、平均动脉压(MAP)、脑电双频谱指数(BIS)和近似熵(ApEn)变化。结果:HR在T2、T3和T4均较T1值升高(P0.01～0.05)。MAP在T2时较T1值降低(P0.05),T3、T4较T1值升高(P0.05),而T4比T3明显升高(P0.01)。BIS值在麻醉后各时点均较T1值下降明显(P0.01),其中T4也较T1下降(P0.05),T3与T2时相比明显降低(P0.01),而T4较T3明显升高(P0.01)。近似熵值的T1值均大于其他各时点(P0.01～0.05),其T4较T3时点升高(P0.01),T3较T2时点降低(P0.05)。结论:作为心率变异性的非线性分析方法指标的近似熵分析法,能描述围术期心脏自主神经功能状态的变化,但其与BIS并无相关性。     

参附注射液对腹主动脉瘤开放手术患者机体应激反应的影响

目的 观察腹主动脉瘤开放手术术中参附注射液对患者应激反应与缺血再灌注损伤的影响.方法 选择腹主动脉瘤开放手术的患者50例,随机分成2组,每组各25例.麻醉维持分别采用参附注射液加丙泊酚全凭静脉麻醉组(A组)和单纯丙泊酚全凭静脉麻醉组(B组).麻醉中监测2组患者的血压和心率,并分别于麻醉诱导前(T1)、气管插管前l min(T2)、气管插管后1 min(T3)、切皮后l min(T4)、手术探查(T5)、手术结束(T6)采血测定血浆皮质醇(Cor)、血浆超氧化物歧化酶(SOD)和白细胞介素-6(IL-6)水平.结果 A组血压的稳定性优于B组,A组T4的Cor水平(16.3±5.2)较B组T4(21.4±5.4)低；A组T6的SOD水平(119.38±11.54)较B组T6(228.21±22.18)低；A组T5的IL-6水平(13.5±1.6)较B组T5(16.9±2.4)低.结论 参附注射液能减少腹主动脉瘤开放手术患者机体应激反应与缺血再灌注损伤程度.     

三代喉罩与气管插管在全麻诱导期对循环和BIS的影响

目的比较全麻诱导期三代喉罩(proseal laryngeal mask airway,PLMA)置入和气管内插管对患者心血管反应和BIS的影响。方法选择择期行腹腔镜胆囊切除术(LC)全麻手术的患者60例,ASAⅠ或Ⅱ级,随机均分为气管插管组(A组)和PLMA组(B组)。比较两组患者诱导前(T1)、诱导后(T2)、PLMA置入或气管插管后即刻(T3)、1 min(T4)、3 min(T5)时SBP、HR、BIS值的变化。结果 B组PLMA置入前后SBP、HR、BIS值组内差异无统计学意义;A组T3~T5时SBP明显高于、HR明显快于T2时(P0.05),T3、T4时BIS值明显高于T2时和B组(P0.05)。结论在相同麻醉深度下,全麻诱导期使用PLMA能保持患者循环系统稳定,且不使中枢神经兴奋性增高;用血流动力学的变化预测麻醉深度的变化并不具有特异性。     

脑电双频指数-靶控输注注射泵闭环丙泊酚靶控输注应用于妇科腹腔镜手术的安全效益研究

目的 观察BIS-靶控输注(target controlled infusion,TCI)注射泵闭环丙泊酚TCI对妇科腔镜手术患者丙泊酚的节约效应及血流动力学的影响. 方法 纳入ASA分级Ⅰ、Ⅱ级择期行妇科腔镜手术的患者40例,采用计算机随机数字表分组分为闭环组和开环组,每组20例.闭环组采用BIS监测闭环丙泊酚TCI维持全身麻醉,开环组采用BIS监测下人工调整丙泊酚TCI血浆效应浓度2～5 mg/L维持全身麻醉,BIS目标值50±5;瑞芬太尼血浆效应浓度4μg/L TCI.记录两组在入室后5 min(T0)、诱导后气管插管前(T1)、插管后1 min(T2)、插管后5 min(T3)、手术切皮时(T4)、切皮后30 min(T5)、缝皮(T6)、手术结束(T7)、意识恢复(T8)、拔管即刻(T9)及拔管后5 min(T10)等时点MAP、HR、BIS值的变化,同时记录两组患者诱导及维持丙泊酚用药量、苏醒时间及进入PACU时的疼痛数字评分(numerical rating scale,NRS)及Ramsay镇静评分. 结果 术中维持丙泊酚剂量闭环组[(6.2±1.4) mg· kg-1·h-1]较开环组[(6.9±1.0)mg·kg-1·h-1]降低了10％,两组各时点MAP、HR、BIS差异无统计学意义(P＞0.05),闭环组切皮时MAP、HR、BIS波动明显小于开环组(P＜0.05).两组患者苏醒时间、NRS及Ramsay镇静评分差异无统计学意义(P＞0.05). 结论 BIS-TCI注射泵闭环丙泊酚TCI与常规BIS监测下开环丙泊酚TCI可同样安全地应用于临床,可对患者个体化合理给予全身麻醉药物,并可部分降低术中丙泊酚使用剂量,降低麻醉后手术前的循环波动.同时,避免麻醉医师手动调控TCI靶控血浆浓度,极大地降低了麻醉医师的工作量,并使围麻醉期更加平稳安全.     

不同剂量依托咪酯用于老年患者麻醉诱导气管插管时对镇静深度的影响

目的观察不同诱导剂量依托咪酯复合舒芬太尼用于老年患者麻醉诱导对镇静深度的影响。方法 65岁以上老年患者60例,按照依托咪酯诱导剂量随机分为四组:A组0.2 mg/kg,B组0.3 mg/kg,C组0.4 mg/kg,D组0.5 mg/kg。观察并记录诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后1 min(T3)、3 min(T4)和5 min(T5)的MAP、HR和BIS变化。结果 A、D组血流动力学波动比B、C组明显。T2~T5时D组BIS明显低于其它三组(P<0.05或P<0.01),T4、T5时A组BIS明显高于其它三组(P<0.01)。结论依托咪酯0.3~0.4 mg/kg复合舒芬太尼0.3μg/kg较适合老年患者麻醉诱导,镇静深度适中,循环较平稳。     

右美托咪定对七氟醚吸入诱导喉罩插入时应激反应及脑电双频指数的影响

目的 观察右美托咪定(Dex)对七氟醚吸入诱导喉罩插入时应激反应及脑电双频指数(BIS)的影响.方法 择期全麻患者60例,年龄20～60岁,ASA Ⅰ或Ⅱ级,随机均分为D1组、D2组和C组,分别于麻醉诱导前15 min静脉输注Dex 0.5、1.0 μg/kg和生理盐水,均以七氟醚复合琥珀胆碱1.0 mg/kg麻醉诱导.记录输注Dex前即刻(T0)、输注后5 min(T1)、喉罩插入前即刻(T2)、喉罩插入后1 min(T3)、3 min(T4)、5 min(T5)时的BIS、MAP、HR,并于T0、T1、T2和T5时抽取静脉血2.5 ml检测血糖(BG)和血浆皮质醇(Cor)浓度.结果 T1时D1和D2组HR、BIS和Cor较T0时降低,BG升高(P<0.05),D2组较D1组更显著(P<0.05);诱导过程中D2组心动过缓的发生率高于C组和D1组.喉罩插入后,C组MAP、HR、BIS、Cor和BG均显著升高(P<0.01);D1组Cor升高,D2组Cor降低(P<0.05),D1和D2组MAP和HR均升高(P<0.05),BIS和BG未见明显变化.除BG外,D1和D2组各指标均低于C组,D2组更显著(P<0.05).结论 Dex 0.5、1.0 μg/kg均可降低BIS,产生明显镇静效应,抑制七氟醚吸入诱导喉罩插入时的应激反应;Dex 1.0 μg/kg的作用更加理想,但要注意防止围麻醉期出现的严重心动过缓.     

缺血后处理对兔肝脏热缺血再灌注损伤的保护

目的探讨缺血后处理对肝脏热缺血再灌注损伤的保护作用。方法阻断肝十二指肠韧带建立兔肝脏热缺血再灌注模型,将30只健康新西兰大耳白兔随机分为假手术(S组)、缺血再灌注(IR组)、缺血后处理(IP组)3组,每组10只。S组只分离肝十二指肠韧带,不阻断;IR组分离并阻断肝十二指肠25min后再恢复灌注;IP组分离并阻断肝十二指肠韧带,于肝脏缺血25min后恢复血灌前阻断、复灌各1min共3个循环进行缺血后处理。观察麻醉诱导后20min(T0)、阻断肝十二指肠韧带25min(T1)、开放30min(T2)、开放1h(T3)、开放2h(T4)、开放4h(T5)血流动力学、谷丙转氨酶(ALT)变化,并检测肝组织中丙二醛(MDA)、超氧化物歧化酶(SOD)变化。结果与IR组比较,IP组T2时HR,T2、T5时SBP及T5时DBP较IR组高;复灌后(T2～T5)血浆ALT明显降低,肝组织中MDA明显下降,而SOD明显升高(P<0.05)。结论缺血后处理可减轻肝脏缺血再灌注损伤。     

EEG bispectral index during carotid endarterectomy

PURPOSE: Carotid endarterectomy (CEA) is an established surgical procedure for the treatment of internal carotid artery stenosis. Stroke is the commonest risk factor during CEA, therefore, cerebral monitoring became essential. Currently the EEG bispectral index (BIS) is used as a monitor of depth of anesthesia and it has showed decreasing trend during cerebral ischemia. We conducted this study to document the changes of the BIS variable during CEA under anesthesia. METHODS: Ten patients who underwent CEA under general anesthesia were studied. The EEG BIS was measured during the perioperative period where five phases were identified: (A) before induction of anesthesia, (B) before clamping of ICA, (C) during clamping of ICA, (D) after declamping of ICA and (E) during the recovery from anesthesia. RESULTS: The age ranged between 53-69 yr. The mean values of the BIS were 91.4 +/- 5.6, 59.6 +/- 18.7, 44.3 +/- 6.8, 54.7 +/- 8.3 and 72.1 +/- 12.4 during A, B, C, D and E phases respectively with statistical significant low values during B, C, D and E phases versus phase A. CONCLUSION: The decreasing trend of the EEG BIS was shown during ICA clamping and whether this is an important quantitative variable to determine the adequacy of cerebral perfusion during CEA yet to be further studied.     

Does bilateral bispectral index monitoring (BIS) detect the discrepancy of cerebral reperfusion during carotid endarterectomy?

The case of a 70 year-old man undergoing bilateral carotid endarterectomy (CEA), for whom alterations in his bispectral index (BIS) values were noted during general anesthesia, is presented. Prior to bypass of the internal carotid artery (ICA), there were no significant differences in bilateral BIS values. After bypass of the left ICA, the left BIS increased to approximately 60, while the right BIS remained at 40. Four months later, no such phenomenon was found during a right CEA. BIS is useful in detecting cerebral hypoperfusion during a lower limit of autoregulation. Attaching bilateral BIS monitors may indicate successful reperfusion of cerebral blood flow in CEA.     

Impact of external carotid artery occlusion at declamping of the external and common carotid arteries during carotid endarterectomy on development of new postoperative ischemic cerebral lesions

Objective

The external carotid artery (ECA) is inadvertently occluded during carotid endarterectomy (CEA). The importance of ECA occlusion has been emphasized as a loss of extracranial to intracranial collaterals, a source of chronic embolization, or a site for extended thrombosis during wound closure. This study aimed to determine whether ECA occlusion that inadvertently developed during endarterectomy and that was eventually detected using blood flow measurement of the ECA after declamping of all carotid arteries is a risk factor for development of new postoperative ischemic lesions at declamping of the ECA and common carotid artery (CCA) while clamping the internal carotid artery (ICA). This study also aimed to determine whether intraoperative transcranial Doppler (TCD) monitoring predicts the risk for development of such lesions.

S-100B release during carotid endarterectomy under local anesthesia

The neuronal protein S-100B has been found to be an indicator of cellular brain damage. The aim of the study was to evaluate whether cross-clamping of the carotid artery for carotid endarterectomy (CEA) under local anesthesia is associated with the same S-100B release pattern as during general anesthesia, where an increase in S-100B concentration in the jugular vein blood of 120% has been reported. In 45 consecutive patients undergoing CEA under local anesthesia, serum S-100B samples were drawn before surgery (T1), before carotid cross-clamping (T2), before cerebral reperfusion (T3), after reperfusion but before the end of surgery (T4), and 6 hr postoperatively (T5). At T1 and T5, blood samples were drawn only from the radial artery. Intraoperatively (T2-T4), samples were collected from the internal jugular vein additionally. S-100B levels were determined using an immunoluminometric assay (LIAISON) Sangtec 100; Sangtec, Bromma, Sweden). In eight patients, it was necessary to insert an intraluminal shunt because of signs of cerebral ischemia. In the remaining 37 patients, median carotid clamping time was 40 min. There were no neurological complications. There were no differences in baseline S-100B levels regarding gender and symptomatology. Median baseline (T1) and postoperative (T5) S-100B levels were identical (0.077 microg/L). All blood samples from the jugular vein showed significantly higher median S-100B levels than the corresponding arterial blood samples. Only slight increases of 13% and 18% were found during cross-clamping (T3) compared to the first intraoperative measurement (T2) in the venous and arterial samples, respectively, which was followed by decreases of 5% and 18%, respectively (T3-T4). S-100B release did not differ at any time point between patients who needed and patients who did not need a shunt, in either the arterial or the venous blood samples. During uncomplicated CEA under local anesthesia, there is no relevant increase of S-100B. These results are different from those reported when CEA is done under general anesthesia.     

Cerebral oximetry monitoring during carotid endarterectomy: effect of carotid clamping and shunting

Cerebral oximetry is a simple method of measuring regional cerebral oxygen saturation (rSO(2)). One promising application is its use during carotid endarterectomy (CEA) to help minimize the risk of perioperative stroke. The authors used the INVOS-4100 cerebral oximeter at several steps during CEA to measure the effect of carotid clamping and shunting on rSO(2). The authors prospectively evaluated 42 consecutive CEAs in 40 patients. All had CEA under general anesthesia with the routine use of a Javid shunt. The INVOS-4100 oximeter was used to measure rSO(2) before clamping (t1), after clamping but before shunting (t2), 5 minutes after shunt insertion (t3), and after patch closure with reestablished flow (t4). The Wilcoxon signed-rank and rank-sum tests were used for analysis. Clamping of the internal carotid artery (t1 vs t2) resulted in a drop of ipsilateral rSO(2) by -12.3% (p < 0.001). Shunt insertion (t2 vs t3) increased rSO(2) by 10.9% (p < 0.001). Contralateral rSO(2) for the same time periods was insignificant. Patients with preoperative neurologic symptoms had a greater decrease in rSO(2) after clamping (-18.4%) compared with a decrease of -10.4% in asymptomatic patients (p = 0.037). Cerebral oximetry monitoring is simple and inexpensive. The study showed statistically significant changes in rSO(2) as a result of clamping and shunting of the carotid artery. Symptomatic patients had a greater drop in rSO(2).     

Carotid endarterectomy: a study of cerebral oxygen saturation vs stump pressure

BACKGROUND AND AIMS: Carotid endarterectomy (CEA) is an established surgical procedure for treatment of internal carotid artery (ICA) stenosis. To determine whether or not a carotid shunt is necessary to place, some surgeons measure the stump pressure. We conducted the current study in order to identify whether or not cerebral oxygen saturation (rS02%) can serve as another quantitative measurement to determine the need of carotid shunt during CEA. MATERIALS AND METHODS: Ten patients who underwent CEA under general anesthesia were studied. The stump pressure was measured during ICA clamping and rSO2% was measured during three phases: A) prior to ICA clamping, B) during ICA clamping and C) after ICA declamping. The data were subjected to one-way ANOVA and correlation coefficient analysis. The mean age was 62+/-7 yr and the mean body weight was 66+/-7kg. RESULTS: The stump pressure and rSO2% mean values were 45+/-9 mmHg and 57+/-7% respectively during ICA clamping. Correlation coefficient revealed significant positive relationship, r = 0.724(P = 0.009). CONCLUSIONS: rSO2% may serve as another quantitative measurement to determine the need for carotid shunt during CEA surgery. Due to the small number of cases in the current study, the critical rSO2% which warrants carotid shunt placement could not be identified. Therefore, large number of patients are required to define the critical rSO2% during CEA surgery.     

Comparison of the influence of general and regional anesthesia on basic haemodynamic parameters during carotid endarterectomy

Carotid endarterectomy (CEA) is a preventive operation to reduce the incidence of embolic and thrombotic cerebral stroke. CEA carries a significant perioeperartive mortality rate from stroke and myocardial infarction, which may even approach 5%. Thus, anesthetic and surgical techniques are constantly under scrutiny to try to reduce this relatively high incidence of morbidity and mortality. Anesthetic technique for CEA is divided to general (GA) and regional (RA) anesthesia, performed by cervical plexus block. The aim this study was to examine changes of basic haemodynamic parameters, which routinely fallows during CEA in condition of GA and RA. After obtaining institutional approval and informed consent, we randomized 50 patients scheduled for CEA (Tab. 1) in two groups (GA and RA). We fallow blood pressure: systolic (BPs), mean (BPm), diastolic (BPd), heart rate (HR), and RPP index at the examined patients. The examination performed in six control times: before induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes after cross clamping of arteria carotis (T3), 5 minutes after declamping arteria carotis (T4), 10 minutes (T5) and 2 hours after operation (T6). The results of study shows significant changes of blood pressure (BPs and BPm) and RPP index in T2 time in patinets undergoing GA. The changes occurred under influence of induction agent thiopental. These changes were in homeostatic range. In RA patinets, no haemodynamic changes registrated in control times. Therefore, from haemodynamic aspect RA was superior to GA.     

Comparison of two different anesthesia regimens in patients undergoing aortocoronary bypass grafting surgery: sufentanil-midazolam versus remifentanil-propofol

OBJECTIVE: To compare intraoperative hemodynamics and depth of anesthesia using sufentanil-midazolam (SM) versus remifentanil-propofol (RP) anesthesia. DESIGN: Prospective, randomized study. SETTING: Clinical investigation in an urban, university-affiliated hospital. PARTICIPANTS: Forty patients undergoing elective first-time coronary artery bypass graft surgery. Interventions: Twenty patients were anesthetized using SM and 20 patients using RP. MEASUREMENTS AND MAIN RESULTS: Hemodynamic monitoring included a 5-lead electrocardiogram, a radial artery catheter, and a pulmonary artery catheter. Depth of anesthesia was assessed using bispectral index (BIS). Data were obtained after induction of anesthesia (T1), after sternotomy (T2), after pericardiotomy (T3), 5 minutes after cardiopulmonary bypass (CPB) (T4), after closure of thorax (T5), and at the end of surgery (T6). The 2 groups were comparable with regard to demographic and perioperative data. There were no significant differences of any hemodynamic parameter at any time between the 2 groups. In both groups, systemic vascular resistance increased at T2 and decreased at T4 from baseline value (p < 0.05). Cardiac index increased at T4 in both groups from baseline value (p < 0.05); 55% of the patients of both groups needed low-dose dobutamine after CPB. During CPB, 40% of the RP patients needed norepinephrine versus 35% of the SM patients. BIS was lower in the RP than in the SM group at T2 and T3 (p < 0.05). BIS values indicating intraoperative awareness were not noted. CONCLUSION: Both anesthesia regimens provided stable hemodynamics and adequate anesthesia in patients undergoing coronary artery bypass graft surgery.     

Local haemodynamic changes during carotid endarterectomy--the influence on cerebral oxygenation.

OBJECTIVES: To characterize carotid bifurcation haemodynamics and cerebral oxygenation during clamping and at reperfusion after carotid endarterectomy (CEA). MATERIALS AND METHODS: Sixty-two patients with a symptomatic high-grade stenosis of the internal carotid artery (ICA), who underwent CEA under general anaesthesia, were studied prospectively. Measurements of stump-pressure, volume flow (transit time flowmetry) and changes in cerebral oxygenation (near-infrared spectroscopy (NIRS)) were performed. Selective shunting was based on stump pressure only. RESULTS: Stump pressure correlated with both ICA flow before clamping (r=0.45; p=0.03) and changes in cerebral oxygenation (rSO2) during clamping (r=0.61; p=0.002), the latter was reversed by shunt placement. ICA flow before clamping also correlated with changes in rSO2 during clamping (r=0.41; p=0.01). CONCLUSION: Measurements with transit time flowmetry and cerebral oximetry are technically easy and help to determine the need for selective shunting during CEA. High ICA flow before clamping in combination with a low stump pressure usually indicates the need for a shunt. Volume flow measurements may also be useful in the quality assessment of the CEA.     

颈内动脉输注异丙酚对胶质瘤切除术患者的脑保护作用

目的 探讨颈内动脉输注异丙酚对胶质瘤切除术患者的脑保护作用.方法 择期胶质瘤切除术患者40例和立体定向胶质瘤活检术患者20例,年龄40～64岁,体重48～73 kg.采用随机数字表法,将拟行胶质瘤切除术患者随机分为2组(n=20):颈内动脉给药组(IA组)和静脉给药组(Ⅳ组).拟行立体定向胶质瘤活检术患者为对照组(C组),采用2%利多卡因15～20 ml术野局部浸润麻醉.IA组和Ⅳ组采用异丙酚-瑞芬太尼-罗库溴铵行麻醉诱导.IA组麻醉诱导后行颈内动脉穿刺置管,颈内动脉靶控输注异丙酚.两组术中调整异丙酚和瑞芬太尼靶浓度,维持BIS值40～60.间断静脉注射罗库溴铵.术中取胶质瘤组织标本,采用免疫组化法测定胶质瘤组织水通道蛋白1(AQP1)和AQP4表达.于麻醉诱导前(T1)、切皮时(T2)、术毕时(T3)、拔除气管导管时(T4)记录MAP和HR;记录手术时间、麻醉用药情况.结果 与T1时比较,Ⅳ组T2,3时MAP和HR降低(P＜0.05),IA组各时点MAP和HR比较差异无统计学意义(P＞0.05).与IA组比较,Ⅳ组MAP和HR降低(P＜0.05).与C组比较,IA组和Ⅳ组AQP1和AQP4表达下调(P＜0.05).与Ⅳ组比较,IA组异丙酚用量减少(P＜0.05),AQP1和AQP4表达、瑞芬太尼和罗库溴铵用量、手术时间比较差异无统计学意义(P＞0.05).结论 与静脉输注异丙酚相比,颈内动脉途径给药不仅可减少胶质瘤切除术患者异丙酚的用量,而且对其脑保护作用没有影响.

Abstract：

Objective To investigate the cerebral protective effect of intracarotid infusion of propofol in patients undergoing resection of cerebral gliomas. Methods Sixty ASA Ⅰ- Ⅲ patients with cerebral glioma aged 40-64 yr weighing 48-73 kg were enrolled in this study. Forty patients undergoing resection of glioma under general anesthesia were randomly divided into 2 groups ( n = 20 each): intracarotid propofol group (group IA ) and intravenous propofol group (group Ⅳ). Twenty patients undergoing biopsy of glioma under local infiltration anesthesia with 2% lidocaine 15-20 md served as control group (group C). In IA and Ⅳ groups anesthesia was induced with TCI of propofol and remifentanil. Tracheal intubation was facilitated with rocuronium 0.6 mg/kg. The patients were mechanically ventilated. PErCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with TCI of propofol and remifentanil and intermittent iv boluses of rocuronium. In group IA internal carotid artery was cannulated after induction of anesthesia and propofol was administered by TCI via carotid artery while remifentanil was administered by TCI via peripheral vein. BIS was maintained at 40-60 during operation. ECG, MAP, HR, SpO2, PETCO2 and BIS were continuously monitored. MAP and HR were recorded before induction of anesthesia (T1) ,during skin incision (T2 ), at the end of operation (T3), during extubation ( T4 ). The glioma specimens were obtained for microscopic examination and determination of aquaporin 1 and aquaporin 4 ( AQP1, AQP4) expression by immunohistochemistry. Results MAP and HR were significantly decreased at T2 and T3 as compared with the baseline at T1 in group Ⅳ ( P ＜ 0.05), while there was no significant change in MAP and HR after induction of anesthesia in group IA ( P ＞ 0.05). The expression of AQP1 and AQP4 was down-regulated in IA and Ⅳ groups compared with group C (P ＜0.05). The propofol consumption during anesthesia was significantly less in group IA than in group Ⅳ (P ＜0.05). There was no significant diffe-rence in AQP1 and AQP4 expression, the amount of remifentanil and recuronium consumed and duration of operation betweenIA and Ⅳ groups ( P ＞ 0.05). Concltsion Intracarotid propofol can decrease the amount of propofol needed for maintenance of anesthesia as compared with intravenous administration and attenuate brain edema,indicating cerebral protective effect.