异丙酚对颅脑外伤手术病人脑脊液压力的影响

Effect of propofol on cerebrospinal fluid pressure during craniocerebral trauma operations

目的:观察异丙酚在颅脑外伤手术中对脑脊液压力(CSFP)、脑灌注压(CPP)、平均动脉压(MAP)和心率(HR)的影响。方法:30例ASAⅡ-Ⅳ级的颅脑外伤病人行开颅血肿清除术,足背动脉穿刺测MAP,L3-4蛛网膜下腔穿刺置管测CSFP。持续监测并记录麻醉诱导前、静脉注射芬太尼和咪畦安定后、静脉注射异丙酚后2分钟与5分钟时的MAP、HR、SpO2、PERCO2、CSFP、CPP。结果:CSPP在静脉注射异丙酚后2分钟较麻醉诱导前显著下降(P<0.05),5分钟时下降更为显著(P<0.01),10分钟时仍有显著下降。CPP在静注异丙酚后也有显著下降(P<0.01和P<0.05)。MAP在静脉注射异丙酚后2分钟、5分钟较麻醉诱导前显著下降(P<0.01)。HR较麻醉前仅有轻度降低。结论:异丙酚能降低CSFP、CPP和MAP,抑制插管反应,是颅脑手术麻醉的较好选择。

Objective： To investigate the effects of propofol of cerebrospinal fluid pressure（CSFP）, cerebral perfusion pressure（CPP）, mean arterial pressure（MAP） and heart rate（HR） on craniocerebral trauma operations. Methods： In 30 ASA gradeⅠ-Ⅱ craniocerebral trauma patients, a dorsal artery of foot catheter and a subarachanoid catheter were placed respectively prior to induction of anesthesia. CSFP, CPP, MAP and HR were monitored before induction, after intravenous Fentanyl and Midazolam, at 2 min and 5 rain after intravenous propofol. Results： Compared with the preanesthetic baseline data, CSFP, CPP and MAP decreased significantly after intravenous propofol. No significant change in HR was found. Conclusion： After intravenous propofol, CSFP, CPP and MAP decreased significantly and intubation sponse was also abated. Prpofol can be a good choice in the anesthesia management of patients undergoing intracranial operations.