七氟醚与异丙酚对颅内动脉瘤夹闭术患者脑能量代谢影响的比较

目的 比较七氟醚与异丙酚对颅内动脉瘤夹闭术患者脑能量代谢的影响.方法 择期拟行颅内动脉瘤夹闭术的患者68例,ASA分级Ⅱ级或Ⅲ级,年龄22 ～ 62岁,体重52～81 kg,Hunt- Hess 分级Ⅱ或Ⅲ级,采用随机数字表法,将其随机分为2组(n=34):异丙酚组(P组)和七氟醚组(S组).麻醉诱导时P组靶控输注异丙酚,血浆靶控浓度2.0 μg/ml,S组吸入8％七氟醚.麻醉维持时P组靶控输注异丙酚,血浆靶浓度1.5 μg/ml,S组吸入2％七氟醚.于临时阻断前5 min(T0)、临时阻断5 min(T1)、10min(T2)、15 min(T3)、动脉瘤夹闭10 min (T4)、20 min (T5)和40 min (T6)时,收集脑组织微透析液,采用邻苯二甲醛柱前衍生反相高效液相色谱分析法结合荧光法检测微透析液葡萄糖、乳酸和丙酮酸浓度,计算乳酸/丙酮酸比(L/P比).结果 与P组比较,S组T1～ T6时微透析液葡萄糖、乳酸和丙酮酸浓度升高,T2～T4时L/P比降低(P＜0.05).与T0时比较,两组T1～T6时微透析液葡萄糖浓度降低,乳酸浓度升高,T1～T4时丙酮酸浓度降低,T5、T6时丙酮酸浓度升高,T1～T5时L/P比升高(P＜0.05)；与T3时比较,两组T～T6时微透析液葡萄糖浓度和丙酮酸浓度升高,L/P比降低,T5、T6时乳酸浓度降低(P＜0.05).结论 七氟醚改善颅内动脉瘤夹闭术患者脑能量代谢的效果优于异丙酚.

Effect of sevoflurane versus propofol on cerebral energy metabolism in patients undergoing intracranial aneurysm clipping

Objective To compare the effect of sevoflurane and propofol on cerebral metabolism in patients undergoing intracranial aneurysm clipping.Methods Sixty-eight ASA Ⅱ or Ⅲ patients aged 22-62 yr weighing 52-81 kg with Hunt-Hess Ⅱ or Ⅲ undergoing intracranial aneurysm clipping were randomly divided into 2 groups( n =34 each): group propofol(group P) and group sevoflurane (group S).Anesthesia was induced with target-controlled infusion(TCI) of propofol (target plasma concretration 2.0 μg/ml,group P) or inhalation of 8％sevoflurane (group S) and iv injection of remifentanil 0.8 mg/kg and atracurium 0.5 mg/kg.Anesthesia was maintained with TCI of propofol(target plasma concretration 1.5 μg/ml,group P) or inhalation of 2％ sevoflurane (group S) and TCI of remifentanil (target plasma concretration 2.0-3.5 ng/ml) and infusion of atracurium (4μg· kg- 1 · min- 1 ).Samples of dialysate in brain were collected at 5 min before temporary arterial occlusion (T0 ),5 min (T1),10 min (T2 ),15 min (T3) of temporary arterial occlusion,and 10 min (T4),20 min (T5),40 min (T6 ) after cerebral aneurysm clipping for determination of glucose,lactate and pyruvate concentrations.Lactate/pyruvate(L/P) ratio was calculated.Results Compared with group P,the concentrations of glucose,lactate and pyruvate were significantly increased at T1 -06,and L/P ratio was decreased at T2-T4 in group S( P ＜ 0.05).The glucose concentration was significantly lower,and lactate concentration higher at T1 -T6,pyruvate concentration was lower at T1 -T4,and higher at T5 and T6,and L/P ratio was higher at T1 -T5 in both groups than that at T0 ( P ＜0.05).The concentrations of glucose and pyruvate were higher and L/P ratio was lower at T4-T6,and lactate concentration was lower at T5,T6 in both groups than that at T3 ( P ＜ 0.05).Conclusion Compared with propofol,sevoflurane can better improve cerebral metabolites in patients undergoing intracranial aneurysm clipping.