七氟醚对颅脑手术围术期脑氧脑糖代谢的影响

The Effect of Anesthesia with Sevoflurane on Brain Oxygen and Glucose Metabolism during Perioperative

目的观察七氟醚吸入麻醉下神经外科手术患者脑组织的氧及糖代谢变化。方法神经外科择期手术患者30例,麻醉诱导采用丙泊酚2 mg.kg-1、舒芬太尼0.5μg.kg-1、维库溴铵0.1 mg.kg-1静脉注射;持续吸入七氟醚和间断静脉注射舒芬太尼和维库溴铵维持麻醉。在麻醉诱导前、切皮前、术毕、拔管后10 min分别采取颈内静脉球部血及桡动脉血进行血气分析,测定和计算各时相脑动静脉血氧含量差(Da-jvO2)、脑动静脉血糖含量差(Da-jvGlu)、脑动静脉乳酸含量差(Da-jvLac)。结果Da-jvO2在切皮前、术毕、拔管后10 min均比麻醉前下降(P<0.05);Da-jvGlu在切皮前、术毕、拔管后10 min与麻醉前比较降低,但差异无显著性(P>0.05);Da-jvLac在术毕、拔管后10 min与麻醉前相比,差异有显著性(P<0.05)或极显著性(P<0.01)。结论七氟醚吸入麻醉可以降低脑氧代谢,对脑糖代谢无明显影响。

Objective To observe the changes of metabolism of cerebral oxygen, glucose and lactate during anesthesia with sevoflurane in neurosurgery procedure. Methods Thirty patients scheduled for neurosurgery were induced with propofol 2 mg·kg^-1 ,sulfentany 0.5 μg·kg^-1, vecurnium bromide 0. 1 mg·kg^-1, and maintained with sevoflurane inhalation and intermittent i. v boluses of sulfenany and vecumium bromide. Blood samples were taken from both artery and jugular venous bulb to detect blood gas and glucose during pre-inducation, discission, operation completion and 10 min after extubation. The content difference of oxygen, glucose and lactate between arterial and jugular bulb （ Da-jvO2, Da-jvGlu and Da-jvLac, respectively） was analyzed at each time phase. Results Da-jvO2 was significantly lower at before discission, closure completion, 10 min after extubation, compared with pre-inducation （ P 〈 0. 05 ）. Da-jvGlu was moderately decreased at before discission, closure completion, 10 min after extubation, compared with pre-induction. Da-jvLac was remarkedly increased at closure completion and 10 min after extubation than that at pre-inducation （ P 〈 0.05 and P 〈 0. 01, respectively ）. Conclusion Sevoflurane anesthesia might decrease cerebral oxygen extraction, but not strongly impact on cerebral glucose extraction.