异泊酚对颅脑手术中脑脊液压力的影响

Effects of propofol on cerebrospinal fluid pressure in patients underwent intracranial operation

目的:观察异泊酚对颅脑手术患者麻醉诱导时平均动脉压(MAP)、心率(HR)、脑灌注压(CPP)和脑脊液压力(CSFP)的影响。方法:对20例符合美国麻醉学家学会(ASA)分级标准Ⅰ～Ⅱ级额叶肿瘤择期手术患者行蛛网膜下腔穿刺置管监测CSFP。静脉注射(静注)芬太尼2μg/kg、咪达唑仑0.04～0.05mg/kg和异泊酚2mg/kg,异泊酚首量5min后,再追加异泊酚1mg/kg,监测并记录异泊酚注射后2min、5min以及追加异泊酚后2min、5min和10min的CSFP、MAP、HR、脉氧饱和度(SpO2)、终末潮气二氧化碳分压(PETCO2)。结果:静注异泊酚2mg/kg,2min后CSFP较麻醉前显著下降(P<0.05),5min和追加异泊酚1mg/kg后2min(气管插管时)、5min时CSFP较麻醉前下降更为明显(P<0.01)。MAP在静注异泊酚2mg/kg后2min、5min和追加异泊酚1mg/kg后2min、5min均较麻醉前明显下降(P<0.05和P<0.01)。CPP在静注异泊酚2mg/kg后2min和5min均较麻醉前明显下降(P<0.01和P<0.05)。HR在静注异泊酚后较麻醉前无显著变化(P>0.05)。结论:异泊酚能抑制气管插管反应,是颅脑手术麻醉的较好选择。

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 in patients underwent intracranial operation. Methods ： In 20 patients scheduled for elective craniotomy, an epidural catheter was placed into subarachanoid. Fentanyl（2μg/kg）, intravenousl Midazolam （0.04 -0.05 mg/kg） and propofol （2 mg/kg） were administered respectively prior to induction of anesthesia. CSFP, MAP, CPP and HR were monitored at 2 min,5 min after propofol administration and 2,5,10 min after another supplementary dose of propofol 1 mg/kg addendum during endotracheal intubation. Results： Compared with the preanesthetic baseline values, CSFP, CPP, and MAP all decreased significantly during induction（P 〈 0.05 ）. While the HR was not significantly different. Conclusion： Propofol may be a good choice as an induction agent in the patients underwent intracranial operations.