七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者脑血流量和颅内压的比较

Comparison of cerebral blood flow and intracranial pressure during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia

目的 比较七氟醚和异丙酚复合麻醉下妇科腹腔镜手术患者的脑血流量（CBF）和颅内压（ICP）.方法 择期拟行妇科腹腔镜手术患者40例,年龄20～59岁,体重44～69kg,ASA Ⅰ或Ⅱ级,随机分为2组（n=20）：七氟醚复合麻醉组（S组）和异丙酚复合麻醉组（P组）.麻醉诱导：S组吸人8%七氟醚,P组TCI异丙酚（Ce 4μg/ml）,两组均TCI瑞芬太尼（Ce 6ng/ml）,睫毛反射消失后,静脉注射顺阿曲库铵0.15mg/kg,BIS〈45时行气管插管.麻醉诱导后瑞芬太尼Ce下调为3 ng/ml,调节异丙酚Ce和七氟醚吸人浓度,维持BIS 45～50,于麻醉诱导前水平仰卧位稳定后5 min（T1）、水平截石位稳定后5 min（T2）、气管插管后即刻（T3）、气管插管后5 min（T4）、气腹头低位后即刻（T5）、气腹头低位后15 min（T6）及气腹放气后10 min（T7）时采用经颅多普勒超声测定大脑中动脉脑血流速率（CBFV）和搏动指数（PI）.结果 与T1时比较,P组T3,4,7时CBFV降低,T3,4时P1降低,S组T4,7时CBFV降低,两组T5,6时PI升高（P〈0.05）;与T4时比较,两组T5,6时CBFV升高（P〈0.05）;与S组比较,P组T3时CBFV降低,T3,4时PI降低（P〈0.05）.结论 与七氟醚复合麻醉相比,异丙酚复合麻醉下妇科腹腔镜手术患者麻醉诱导后CBF和ICP明显降低;气腹后CBF和ICP均升高.

Objective To compare the cerebral blood flow （CBF） and intracranial pressure （ICP） during laparoscopic gynecologic surgery performed under propofol and sevoflurane combined anesthesia.Methods Forty ASAⅠ orⅡ patients aged 20-59 yr weighing 44-69 kg were randomly divided into 2 groups（n=20 each）：propofol group （group P） and sevoflurane group （group S）.Anesthesia was induced with TCI of propofol （Ce 4μg/ml） in group P or 8% sevoflurane in group S combined with TCI of remifentanil （Ce 6 ng/ml）.Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of propofol or sevoflurane.inhalation combined with TCI of remifentanil.BIS value was maintained at 45-50 by adjusting Ce of propofol or concentration of sevoflurane.Intraabdominal pressure （IAP） was maintained at 12-14 mm Hg.Transcranial Doppler monitoring wag used.Cerebral blood flow velocity （CBFV） and pulsatility index （PI） were recorded at 5 min after supine position（T1）and 5 min after supine lithotomy position before induction（T2）,while tracheal tube was being inserted（T3）,5 min after tracheal intubation（T4）,immediately and 15 min after abdominal CO2 iusnfflation in trendelenburglithotomy position （T5,T6） and at 10 min after deflation of abdomen（T7）.Results CBFV was significandy decreased at T3,T4 and T7 in group P and at T4 and T7 in group S as compared with the baseline at T1.CBFV at T3 was significantly lower in group P than in group S.PI at T3,T4 was significantly decreased in group P as compared with the baseline at T1 and was significantly lower than in group S.PI at T5,6 was significantly increased as compared with the baseline in both groups but was not significantly different between the 2 groups.Conclusion When combined with remifentanil.propofol could decrease CBF and ICP while sevoflurane has no significant effect on CBF and ICP after induction.CBF and ICP are significantly increased in both groups after abdominal CO2 insufflation.