异丙酚和依托咪酯全麻诱导对重症颅脑损伤患者脑氧代谢的影响

Effect of propofol and etomidate on cerebral oxygen metabolism in severe traumatic brain injury patients during general anesthesia induction

目的观察异丙酚和依托咪酯在全麻诱导时对重症颅脑损伤患者脑氧代谢的影响。方法30例重症颅脑损伤术前经CT诊断,GCS(glasgowcomascale)评分≤7需急诊手术患者,随机分为两组,异丙酚组15例行咪唑安定0.1mg·kg-1、芬太尼4μg·kg-1、异丙酚1mg·kg-1、维库溴铵0.1mg·kg-1快诱导,依托咪酯组15例在上述基础上由依托咪酯0.2mg·kg-1代替异丙酚,观察两组患者麻醉前(T0)、诱导后2min(T1)、插管后2min(T2)插管后10min(T3)及插管后30min(T4)收缩压、舒张压、心率以及在相应时间抽取桡动脉和颈内静脉球处血液行血气分析,根据各时间的血气分析计算颈内静脉球、桡动脉处血氧含量、脑氧摄取率。结果全麻诱导后氧供明显改善,两组患者脑氧代谢率均降低,但在插管后2min异丙酚组下降更明显(P<0.05),异丙酚组血液动力学波动明显大于依托咪酯组(P<0.05)。结论异丙酚诱导对重症颅脑损伤患者血流动力学波动明显大于依托咪酯,但与依托咪酯相比更能降低患者的脑氧摄取率,可能对重症颅脑损伤患者更为有利。

Objective To investigate the effects of propofol and etomidate on cerebral oxygen metabolism in patients with severe traumatic brain injury(STBI)during general anesthesia induction.Methods Thirty patients with severe traumatic brain injury and Glasgow coma scale(GCS)≤7,needed emergency operation.They were randomly divided into two groups.In propofol group(n=15),patients were quickly induced by midazolam 0.1 mg·kg~ -1,fentanyl 4 μg·kg~ -1,propofol 1 mg·kg~ -1,vecuronium 0.1 mg·kg~ -1.In etomidate group(n=15),patients were quickly induced by the same but etomidate 0.2 mg·kg~ -1 instead of propofol.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)before narcosis(T_0),2 minutes after induction(T_1),2 minutes(T_2),10 minutes(T_3)and 30 minutes(T_4)after tracheal intubation were observed.At the same time blood was collected from radial artery and jugular bulb venous for blood gas analysis,and the oxygen content of artery(CaO_2),oxygen content of jugular venous(CjvO_2)and cerebral metabolic rate for oxygen(CERO_2)were calculated.Results The oxygen supply was significantly better after general anesthesia induction,cerebral oxygen metabolic rate was lower than before anesthesia induction in the two groups,but CERO_2 was more significantly decreaseds in propofol group than in etomidate group(P<0.05),the haemodynamics was more stable in etomidate group than propofol group.Conclusion There is bmore significant effect on haemodynamic in patients with severe traumatic brain injury when induced by propofol than etomidate,but propofol could more significantly decrease the CERO_2.Propofol may be more beneficial to patients with severe traumatic brain injury during general anesthesia induction.