异丙酚对颅内压的影响

Influence of propofol on the intracranial presure of neurosurgery patient during anesthesia induction

目的：评价异丙酚对神经外科病人颅内压的影响。方法：１３例颅内胶质瘤成年病人ＡＳＡⅠ～Ⅱ级，择期行开颅手术。在麻醉诱导时，静注异丙酚２ｍｇ／ｋｇ。分别于注药前、后１、２、３、５、７、１０、１５和２０分钟，观察收缩压（ＳＰ），舒张压（ＤＰ），平均动脉压（ＭＡＰ），心率（ＨＲ），脑灌注压（ＣＰＰ），颅内压（ＩＣＰ）的变化。颅内压监测采用腰蛛网膜下腔置管直接测压。结果：静注异丙酚后ＳＰ，ＭＡＰ，ＣＰＰ显著降低（１５．１８±２．２１ｋＰａ降至１３．４４±１．５６ｋＰａ，１１．３３±２．１４ｋＰａ降至９．５４±１．７０ｋＰａ，９．０５±２．４６ｋＰａ降至７．９７±２．１４ｋＰａ）但是随着时间的延长在２０分钟内恢复至基础水平，ＤＰ、ＨＲ给药前后无明显变化，ＩＣＰ给药后明显下降且在观察期内无回升趋势。结论：异丙酚能降低病人的颅内压，适用于神经外科麻醉，对颅内压增高病人应适当调整用量。

Objective:To evaluate the intracranial pressure(ICP) changes of neurosurgery patient after intravenous propofol injection.Method:ICP was measured by directly subarachnoid space tube inserted.After propofol 2mg/kg intravenous injection,systolic pressure(SP),diastolic pressure(DP),mean arterial pressure(MAP),cerebral perfusion pressure(CPP) and ICP were determined 1,2,3,5,7,10,15 and 20 minutes after the injection.Result:SP,MAP and CPP were decreased significantly after propofol injection(from 15 18±2 21 to 13 44±1 56kPa,11 33±2 14 to 9 54±1 70kPa and 9 05±2 46 to 7 97±2 14 kPa,respectively),but they recovered to normal level later,while DP and HR didnot significantly change.ICP also decreased(from 2 26±1 40 to 1 57±1 22kPa) and was kept at the low level during whole observation.Conclusions:Propofol can decrease patients ICP and may be an efficient anesthetic for neurosurgery.