丙泊酚对颅内手术麻醉诱导期脑脊液压力的影响

目的　观察丙泊酚对颅内手术病人麻醉诱导时脑脊液压力 (CSFP)、脑灌注压 (CPP)、MAP和HR的影响 ,探讨其在神经外科麻醉中的应用价值。方法　 2 0例ASAⅠ～Ⅱ级颞叶肿瘤择期手术病人 ,入室后行L3～ 4蛛网膜下隙穿刺置管监测CSFP。麻醉诱导气管内插管后 ,吸入异氟醚维持。持续监测并记录麻醉诱导中、静注芬太尼 2 μg/kg和咪唑安定 0 0 4～ 0 0 5mg/kg、静注丙泊酚2mg/kg后 2分钟、5分钟及追加丙泊酚 1mg/kg后 2分钟、5分钟和 10分钟的CSFP、MAP、HR、SpO2 、PETCO2 。结果　静注丙泊酚 2mg/kg 2分钟后CSFP较麻醉前显著下降 (P <0 0 5 ) ,5分钟和追加丙泊酚 1mg/kg后 2分钟 (气管插管时 )、5分钟时CSFP较麻醉前下降更为显著 (P <0 0 1)。MAP在静注丙泊酚 2mg/kg后 2分钟、5分钟和追加丙泊酚 1mg/kg后 2分钟、5分钟都较麻醉前明显下降 (P <0 0 5和P <0 0 1)。CPP在静注丙泊酚 2mg/kg后 2分钟和 5分钟均较麻醉前显著下降(P <0 0 1和P <0 0 5 )。HR在静注丙泊酚后较麻醉前仅有轻度降低。结论　静注丙泊酚能降低CSFP、MAP和CPP ,抑制插管反应 ,其程度与剂量相关 ,丙泊酚是颅内手术麻醉的较好选择。

Effect of propofol on cerebrospinal fluid pressure in patients undergoing intracranial operation during induction

Objective To investigate the effects of propofol on cerebrospinal fluid pressure (CSFP),mean arterial pressure (MAP),cerebral perfusion pressure (CPP) and heart rate(HR) during induction of anesthesia.Methods In 20 patients scheduled for elective craniotomy,a radial artery catheter and a subarachanoid catheter were placed respectively prior to induction of anesthesia.CSFP,MAP,CPP and HR were monitored at 2min,5min after intravenous propofol 2mg/kg and added another supplementary dose of propofol 1mg/kg were administered 2min prior to endotracheal intubation.Results Compared with the preanesthetic baseline data,CSFP,CPP and MAP decreased significantly during induction.No significant change in HR was noted.Conclusion During induction of anesthesia,CSFP,CPP and MAP decreased significantly after intravenous propofol 2 3 mg/kg,intubation sponse was also abated.Propofol can be a good choice as an induction agent in the anesthesia management of patients undergoing intracranial operations.