地氟醚维持麻醉对S_(jv)O_2和CSFP的影响

目的 :研究地氟醚维持麻醉时PaCO2 对SjvO2 和CSFP的影响。方法 :43例脑肿瘤病人用地氟醚维持麻醉 ,术中持续监测颅内压和动脉压。当人为改变PETCO2 时 ,取颈内静脉血和同步采集动脉血作血气分析和测定两者乳酸含量。结果 :地氟醚浓度 <1MAC时 ,ICP随PaCO2 变化而变化 ,SjvO2 与PaCO2 呈显著正相关 ,低PaCO2 可能增加脑静脉血乳酸含量。地氟醚 >1MAC时 ,SjvO2 与PaCO2 相关性差 ,静脉乳酸含量变化小。正常CPP条件下进行过度通气时 ,SjvO2 值仅与地氟醚浓度呈显著正相关。结论 :神经外科病人用地氟醚维持麻醉时 ,浓度为≤ 1MAC维持脑静脉血氧饱和度对二氧化碳反应性 ,可能具有剂量依赖性脑血管扩张效应。     

地氟醚和安氟醚麻醉对心肌酶的影响

地氟醚是一种新吸入麻醉药物 ,已应用于临床各科手术的麻醉。但从酶学方面来了解地氟醚对心肌影响的研究较少。本文旨在研究常规手术患者在吸入地氟醚麻醉下血清心肌酶 [肌酸激酶(ＣＫ)、肌酸激酶同工酶 (ＣＫＭＢ)、乳酸脱氢酶 (ＬＤＨ)、羟基丁酸脱氢酶 (ＨＢＯＨ) ]的变化 ,并与吸入安氟醚麻醉下血心肌酶变化进行比较。资料和方法30例患者随机分成 2组。地氟醚组(Ｄ) 15例 :男 7例 ,女 8例 ,平均年龄46 2 6岁 ,普通外科手术 9例 ,妇科手术 6例 ;安氟醚组 (Ａ) 15例 ,男 9例 ,女 6例 ,平均年龄 42 33岁 ,普通外科手术 8例 ,妇科手术 5例…     

地氟醚麻醉用于颅内手术的临床观察

目的探讨地氟醚麻醉用于颅内手术时颅内压的改变。方法16例颞叶肿瘤择期手术病人,麻醉诱导气管内插管后,吸入1MAC地氟醚维持,监测并记录麻醉前、诱导中、麻醉后20、30、40、50分钟的脑脊液压力(CSFP)、MAP和的变化。结果在维持28～31mmHg水平的条件下,全麻诱导期CSFP、MAP明显下降(P＜0．01)。吸入1MAC地氟醚后CSFP逐渐上升;但50分钟后仍低于麻醉前水平,MAP明显低于麻醉前(P＜0．01)。结论神经外科手术应用异丙酚诱导,保持在28～30mmHg,吸入1MAC地氟醚维持麻醉不增加颅内压。     

地氟醚与异氟醚麻醉对小儿循环功能的影响

目的：比较地氟醚和异氟醚麻醉对小儿血液动力学的影响。方法：28例1－5岁小儿，ASAI－Ⅱ级，快速诱导气管插管后随机分为地氟醚（D）帮异氟醚（I）两组，每组14例。分别测量呼气末麻醉药浓度为0、0．5、1．0和1．5MAC稳定5分钟后的SI、CI、SVR、HR及MAP。结果：与0MAC比较，0．5MAC时两组MAP和SVR均略有降低（P＜0．05），其他指标均无明显变化（P＞0．05）。1．0MAC时，SVR和MAP进一步降低，其幅度两组间无显著差异；HR和SI均略有升高，但无显著差异；CI值D组显著高于I组。达1．5MAC时，D组的HR显著高于I组，而SI下降与0MAC近似；SVR和MAP两组无进一步降低。结论：地氟醚和异氟醚麻醉对小儿心肌收缩功能均有一定抑制作用,但地氟醚使小儿HR增快的作用大于异氟醚。     

比较七氟醚、异氟醚和安氟醚对颅内压的影响

目的：为了观察七氟醚对颅内压的影响。方法：选择２４例颅内肿胶病人,测定七氟醚麻醉的时颅内压变化并与异氟醚和安氟醚进行比较。术前用药、麻醉诱导及维持的静脉用药相同。于Ｌ３－４穿刺蛛网膜睛腔测脑脊液压（代表颅内压,ＩＣＰ）。依吸入药不同随机分为七的氟醚（Ｓ）组,异氟醚（１）组和安氟醚（Ｅ）组,监测ＢＰ、ＭＡＰ、ＥＣＧ、ＳｐＯ２、ＰＥＴ、ＣＯ２和ＭＡＣ,调整ＶＴ和ＲＲａＣＯ２维持在４～４．６６ＫＰＡ。三     

地氟醚、七氟醚和异氟醚对犬冠脉血流的影响

目的：采用超声血流量监测仪观察地氟醚、七氟醚和异氟醚对犬冠脉血流的影响。方法：犬１８只，腹腔注射１．５％硫喷妥钠２０ｍｇ／ｋｇ，静脉注射阿曲库铵０．８ｍｇ／ｋｇ麻醉诱导，气管插管后取正中开胸，分离冠状动脉左前降支，将３ｍｍ或３．５ｍｍ超声Ｄｏｐｐｌｅｒ血管探头置于分离血管处，连接超声多普勒冠脉血流量监测仪测定冠脉血流量，然后随机吸入地氟醚、七氟醚或异氟醚，ＭＡＣ分别为７．２％、２．３％和１．２８％     

地氟醚、七氟醚和异氟醚对内源性一氧化氮的影响

目的：观察犬吸入地氟醚、七氟醚和异氟醚后血浆ＮＯ含量的变化，以进一步探讨ＮＯ在囱族吸入麻醉药扩血管作用中的地位。方法：犬麻醉后３０分钟，随机吸入地氟醚、一氟醚或异氟醚（ＭＡＣ ７．２％￣２．３％和１．２８％）使呼气末浓度达１ＭＡＣ，持续３０分钟。分别于呼气末浓度达１ＭＡＣ后５分钟、１５分钟和３０分钟和停吸后３０分钟分钟和１２０分钟抽取静脉血，用硝酸盐还原酶法测定ＮＯ。结果：ＮＯ水平在三组药物吸入过     

地氟醚、七氟醚与安氟醚低流量麻醉临床观察

比较地氟醚、七氟醚、安氟醚用于低流麻醉时ＢＰ和ＨＲ改变,苏醒过程、不良反应以及药物费用。方法：４２例ＡＳＡＩⅠ－Ⅱ级择期腹部外科手术病人随机分成地氟醚,安氟醚和七氟醚三组。麻醉诱导后连接Ｃｉｃｅｒｏ麻醉机。降低新鲜气流,地氟醚和安氟醚为０．３－０．５Ｌ／ｍｉｎ,七氟醚为０．８－１．０Ｌ／ｍｉｎ,从回路呼出端向麻醉机回路内注入液吸入麻醉药４－５分钟内使三组病人呼气末麻醉药浓度达到１ＭＡＣ左右,即地氟     

静吸复合麻醉下七氟醚与异氟醚对颅内压的影响

目的:在颅内顺应性正常神经外科病人,观察1.0 MAC七氟醚与异氟醚对颅内压的影响。方法:垂体瘤或颅咽管瘤手术病人16例,随机分为两组:A组为咪唑安定 芬太尼 1.0 MAC异氟醚;B组为咪唑安定 芬太尼 1.0 MAC七氟醚。选择L_(3～4)行蛛网膜下腔穿刺。麻醉诱导采用芬太尼-咪唑安定-阿曲库铵。插管后维持稳定30分开始吸入七氟醚(或异氟醚)。分别于麻醉前、吸入麻醉药前、达预定呼气末浓度30分内观察监测指标。结果:1.0 MAC七氟醚和异氟醚均可显著降低脑灌注压,异氟醚作用较强。吸入1.0 MAC七氟醚后颅内压首先呈显著性下降,15分后回复至基础水平。吸入1.0 MAC异氟醚后颅内压无显著性变化。结论:在颅内顺应性正常患者,1.0 MAC七氟醚和异氟醚均可安全用于神经外科麻醉。     

地氟醚、七氟醚和异氟醚对犬血液动力学和氧供需平衡的影响

目的　采用连续温度稀释法观察不同浓度地氟醚对血液动力学和氧供需平衡的影响 ,并与七氟醚和异氟醚比较。方法　犬 18只 ,1.5 %硫喷妥钠 2 0 mg/ kg、阿曲库胺 0 .8mg/ kg麻醉诱导 ,气管插管后机械通气。左股静脉穿刺置入 7.5 F的六芯肺动脉漂浮导管 ,接 CCO/ SvO2 监测仪 ,连续测定并计算血液动力学及氧供需平衡各项指标。操作完成后平稳 1小时 ,取基础指标。然后随机依次吸入 0 .7、1.2和 1.7MAC的地氟醚、七氟醚或异氟醚 ,呼气末浓度达预定值后稳定 2 0分钟 ,记录各指标 ,再增加吸入浓度达下一个预定浓度。结果　 MAP、SVR和 CO在三组均呈剂量依赖性下降 ,地氟醚和异氟醚组 HR明显增快 ,七氟醚组 HR则明显减慢 ,异氟醚组 1.7MAC时 VO2 增加 ,DO2 和Sv O2 下降。结论　地氟醚对循环功能和氧供需平衡的影响与异氟醚相似 ,与七氟醚则有所不同     

异丙酚麻醉下PaCO2对SjvO2影响的年龄差异

目的研究异氟醚和异丙酚维持神经外科手术中低碳酸和高碳酸血症对颈静脉球血氧饱和度(SjvO     

全身麻醉中脑电双频指数与脑氧代谢率的相关性

目的评估两种麻醉药介导下脑电双频指数(BIS)与脑氧代谢率(CMRO2)的内在联系。方法30例择期全麻自愿者随机分为两组I组为异氟醚麻醉组,Ⅱ组丙泊酚麻醉组。I组将呼气末异氟醚浓度分别控制在0.6%、1.2%、2.4%、3%,同时记录BIS值并测定其对应的颈内静脉血氧饱和度(Sj-VO2);Ⅱ组调整丙泊酚输注速度在4、8、12、16mg.kg-1.h-1,同时记录BIS值并测定其对应的Sj-VO2。结果I组随异氟醚浓度递增,BIS值从76±8逐渐降到34±6,SjV-O2从(73.7±4.6)%升至(76.3±4.2)%,2.4%与3%的异氟醚对应的Sj-VO2差异也有显著意义(P<0.05),BIS值与对应Sj-VO2呈显著线性负相关(r=-0.76,P<0.05)。Ⅱ组,随丙泊酚输注速度递增,BIS值从81±6逐渐降低到38±5,Sj-VO2从(67.6±5.3)%升至(78.3±4.2)%。12mg.kg-1.h-1与16mg.kg-1.h-1丙泊酚输注速度时对应的SjV-O2差异无显著意义。BIS值与对应SjV-O2呈显著线性负相关(r=-0.86,P<0.05)。结论(1)在异氟醚或丙泊酚麻醉时,BIS值随麻醉药剂量增加而显著降低,Sj-VO2则呈逐渐升高趋势。(2)术中血红蛋白和体温及脑血流(CBF)维持恒定,BIS值在30~100之间时,BIS与Sj-VO2呈显著线性负相关。(3)异氟醚或丙泊酚麻醉时,BIS可作为反映CMRO2的指标。     

脑电双频谱分析用于地氟醚复合氧化亚氮吸入时麻醉深度的判断

目的：通过观察地氟醚复合Ｎ２Ｏ吸入麻醉过程中脑电双频谱指数（ＢＩＳ）的进一步评价ＢＩＳ在麻醉深度监测中的应用价值。方法：患者２０例,气管插管后后用５０％Ｏ２＋５０％Ｎ２Ｏ＋地氟醚维持麻醉。地氟醚初始吸入浓度６％,分别于呼气末浓度达到０．５、０．７５、１．０、１．２５６ １．５ＭＡＣ时记录ＢＩＳ、Ｂ客ＨＲ等指标,然后维持呼气末２３．９％（１．３ＭＡＣ０,１５分钟后开始手术,观察切皮时患者有无反应。术     

The effect of Pyrogen Administration on Sweating and Vasoconstriction Thresholds during Desflurane Anesthesia

Background: General anesthetics increase the sweating-to-vasoconstriction interthreshold range (temperatures not triggering thermoregulatory defenses), whereas fever is believed to only increase the setpoint (target core temperature). However, no data characterize thresholds (temperatures triggering thermoregulatory defenses) during combined anesthesia and fever. Most likely, the combination produces an expanded interthreshold range around an elevated setpoint. The authors therefore tested the hypothesis that thermoregulatory response thresholds during the combination of fever and anesthesia are simply the linear combination of the thresholds resulting from each intervention alone.

Methods: The authors studied eight healthy male volunteers. Fever was induced on the appropriate days by intravenous injection of 30 IU/g human recombinant interleukin 2 (IL-2), followed 2 h later by an additional 70 IU/g. General anesthesia consisted of desflurane 0.6 minimum alveolar concentration (MAC). The volunteers were randomly assigned to the following groups: (1) control (no desflurane, no IL-2); (2) IL-2 alone; (3) desflurane alone; and (4) desflurane plus IL-2. During the fever plateau, volunteers were warmed until sweating was observed and then cooled to vasoconstriction. Sweating was evaluated from a ventilated capsule and vasoconstriction was quantified by volume plethysmography. The tympanic membrane temperatures triggering significant sweating and vasoconstriction identified the respective response thresholds. Data are presented as the mean +/- SD; P < 0.05 was considered significant.

Results: The interthreshold range was near 0.4[degree sign]C on both the control day and during IL-2 administration alone. On the IL-2 alone day, however, the interthreshold range was shifted to higher temperatures. The interthreshold range increased significantly during desflurane anesthesia to 1.9 +/- 0.6[degree sign]C. The interthreshold range during the combination of desflurane and IL-2 was 1.2 +/- 0.6[degree sign]C, which was significantly greater than on the control and IL-2 alone days. However, it was also significantly less than during desflurane alone.     

全麻腹腔镜胆囊切除术中PetCO2,PaCO2,PvCO2的变化

报告６例全麻醉腹腔镜胆囊切除术（ＬＣ）患者ＣＯ２气腹前后ＰｅｔＣＯ２，ＰａＣＯ２，ＰｖＣＯ２的变化，全麻诱导后气腹前，气腹后５ｍｉｎ，１５ｍｉｎ及放气后即刻分别记录各监测值。结果显示，气腹后ＰｅｔＣＯ２，ＰａＣＯ２，ＰｖＣＯ２，ＶＤ／ＶＴ，ａ－ｅｔＣＯ２均显著升高，ＰｅｔＣＯ２与ＰａＣＯ２及ＰｖＣＯ２与ＰａＣＯ２在各时刻均显著相关，但气腹后ＰｅｔＣＯ２与ＰｖＣＯ２的相关性变化无规律，ＰｖＣＯ２及Ｐ     

术后不同给氧方式对病人血气的影响

目的探讨心功能Ⅰ～Ⅱ级择期腹部全麻手术病人最佳给氧方式.方法将75例病人随机分为A、B、C三组各25例,分别于术毕拔除气管导管后30 min予鼻导管、Mapleson装置、呼吸机循环半紧闭装置3种方式给氧,观察术前30 min、拔管后30 min、给氧后30 min PaO2、PaCO2值.结果PaO2三组病人给氧后30 min均较给氧前显著升高(均P＜0.01),其中C组最高;PaCO2给氧后30 min B组显著升高(P＜0.01).结论鼻导管给氧仅适用于术后通气无明显抑制的病人;半开放面罩给氧比前者输入的氧流量大,易引起高CO2血症;呼吸机给氧适用于各种通气功能障碍的病人,可有效提高PaO2、降低PaCO2.     

开肺陷胸汤对大鼠胰源性肺损伤的防治效应

目的：在制备大鼠胰源性肺损伤动物模型基础上给予中药治疗，动态观察血氧分压及二氧化碳分压变化，并对肺脏进行病理学分析。方法：实验分为模型组及中药治疗组,72h后观察肺脏病理变化及不同时间血气分析。结果：治疗组肺脏病理改变明显减轻（P＜0．05）；治疗组72h血氧分压明显高于模型组（P＜0．01），血二氧化碳分压明显低于模型组（P＜0．01）。结论：在胰源性肺损伤发病过程中，血氧分压及二氧化碳分压的变化直接反应出肺损伤病理改变的严重程度，治疗组随着氧分压升高，二氧化碳分压降低，标志着肺脏病理改变明显减轻。     

A Comparison of Baroreflex Sensitivity during Isoflurane and Desflurane Anesthesia in Humans

Background: Desflurane anesthesia has been associated with heart rate (HR) and sympathetic nerve activity (SNA) responses that differ from those during isoflurane anesthesia. Whether these differences might be due to better preservation by desflurane of the baroreceptor reflex control of HR or SNA in humans was examined.

Methods: Baroreflex sensitivity was assessed in 18 volunteers anesthetized with either desflurane or isoflurane. Measurements of HR, blood pressure (BP), and efferent SNA (percutaneous recordings from the peroneal nerve) were made, and baroreflex sensitivity was evaluated at conscious baseline and during 0.5, 1.0, and 1.5 MAC anesthesia. Baroreflex responses were triggered by bolus intravenous injections of nitroprusside (100 micro gram) and phenylephrine (150 micro gram). The linear portions of the baroreflex curves relating HR to mean arterial pressure and relating SNA to diastolic pressure were determined to obtain cardiac and sympathetic baroslopes, respectively.

Results: Cardiac (HR) baroslopes were equally diminished at increasing MAC of both anesthetics. Sympathetic baroslopes were preserved at 0.5 MAC isoflurane but diminished at 0.5 MAC desflurane. Higher MAC produced equal depression of sympathetic baroslopes with both anesthetics.     

The Effects of Isoflurane and Desflurane on Intracranial Pressure, Cerebral Perfusion Pressure, and Cerebral Arteriovenous Oxygen Content Difference in Normocapnic Patients with Supratentorial Brain Tumors

Background: Desflurane is a volatile anesthetic agent with low solubility whose use in neurosurgery has been debated because of its effect on intracranial pressure and cerebral blood flow. The purpose of this study was to determine the variations on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as well as on cerebral arteriovenous oxygen content difference (AVDo2) in normocapnic patients scheduled to undergo removal of supratentorial brain tumors with no evidence of mass effect during anesthesia with isoflurane or desflurane.

Methods: In 60 patients scheduled to undergo craniotomy and removal of supratentorial brain tumors with no evidence of midline shift, anesthesia was induced with intravenous fentanyl, thiopental, and vecuronium and was maintained with 60% nitrous oxide in oxygen. Patients were assigned to two groups randomized to receive 1 minimum alveolar concentration isoflurane or desflurane for 30 min. Heart rate, mean arterial pressure, intraparenchymal ICP, and CPP were monitored continuously. Before and after 30 min of continuous administration of the inhaled agents, AVDo2 was calculated.

Results: There were no significant differences between groups in heart rate, mean arterial pressure, ICP, and CPP. ICP measurements throughout the study did not change within each group compared to baseline values. Mean arterial pressure decreased significantly in all patients compared to baseline values, changing from 105 +/- 14 mmHg (mean +/- SD) to 85 +/- 10 mmHg in the isoflurane group and from 107 +/- 11 mmHg to 86 +/- 10 mmHg in the desflurane group (P < 0.05 in both groups). CPP also decreased within each group compared with baseline values, changing from 95 +/- 15 mmHg to 74 +/- 11 mmHg in the isoflurane group and from 95 +/- 16 mmHg to 74 +/- 10 mmHg in the desflurane group (P < 0.05 in both groups). Cerebral AVDo2 decreased significantly in both groups throughout the study, changing from 2.35 +/- 0.77 mm to 1.82 +/- 0.61 mm (mmol/l) in the isoflurane group (P < 0.05) and from 2.23 +/- 0.72 mm to 1.94 +/- 0.76 mm in the desflurane group (P < 0.05), without differences between groups.