异丙酚复合麻醉下开颅手术患者麻醉期体温的变化

Changes of core and peripheral surface temperatures in patients undergoing cranitomy procedures during total intravenous anesthesia of propofol

目的观察异丙酚复合麻醉下开颅手术患者围麻醉期体温度的变化。方法择期行开颅手术患者65例,年龄22-63岁,男38例,女27例,ASAⅠ或Ⅱ级,采用异丙酚复合麻醉。以鼻咽温度代表中心温度,臂-指温度差表示血管收缩程度,体表温度通过。Ramanatyan公式计算。观察诱导前、诱导后即刻、15、30、45、60、90、120、150、180min、停药时、停药后5、10、15、20min的温度、全身耗氧量和产热量的变化。结果与诱导前比较,患者耗氧量和产热量在诱导后15min-停药后10min时均降低,耗氧量和产热量在停药20min时升高,诱导后30-180min时体表温度升高(P<0.05);与停药时比较,停药后15、20min时耗氧量、停药后20min产热量增加(P<0.05);与诱导后即刻比较,中心温度在诱导后90min-停药后20min时降低(P<0.05);平均臂-指温度差在诱导后即刻由>0℃降低到<0℃,停药时又升为>0℃。结论异丙酚复合麻醉开颅手术患者围麻醉期中心温度降低,与体表温度升高、耗氧量和产热量降低有关。

Objective To investigate changes of core and peripheral surface temperatures in patients undergoing cranitomy procedures during total intravenous anesthesia of propofol, and influences of systemic oxygen consumption(SOC) and metabolic heat production(MHP) on core temperatures. Methods Sixty-five ASA Ⅰ or Ⅱ patients of both sexes (38 males, 27 females), aged 22-63 yrs undergoing selective craniotomy procedures were anesthetized with total intravenous anesthesia of propofol. Nasopharyngeal temperatures were measured as core temperature, and forearm-fingertip temperature gradients as marks of peripheral vasodilation and vasoconstriction. Peripheral surface temperature was calculated according to the Ramanatyan formula. All temperatures, oxygen consumption and metabolic heat production were measured at following points: before induction, 0, 15, 30, 45, 60, 90, 120, 150, 180 min after induction, immediately, 5, 10, 15 and 20 min after stopping of propofol infusion.Results Along with deepening of anesthesia, core temperature, SOC, MHP markedly lowered, average body surface temperature increased markedly, Peripheral surface temperature obviously rose, and forearm-fingertip temperature gradients decreased from > 0℃ to < 0℃ . After stopping of propofol infusion, core temperature, SOC and MHP and forearm-fingertip temperature gradients greatly increased, and peripheral surface temperature marked lowered. Conclusion The decrease of core temperature during total intravenous anesthesia of propofol is associated with increase of peripheral surface temperature and decrease of SOC and MHP.