异氟醚控制性降压对血流动力学及血β_2-微球蛋白含量的影响

The changes of hemodynamics and plasma β 2-Microglobulins by deliberate hypotension with isoflurane

目的观察颅内动脉瘤夹闭术行异氟醚控制性降压对血流动力学及血清β２微球蛋白（β２－ＭＧ）含量变化的影响．方法２１例颅内动脉瘤病人于全麻下剥离夹增长动脉瘤时，加大异氟醚吸入浓度，使ＭＡＰ下降２０％～３０％，夹闭动脉瘤后，减少异氟醚浓度，ＭＡＰ回升至降压前水平．采用Ｓｗａｎ－Ｇａｎｚ漂浮导管监测降压前、中、后心血流动力学各指标动态变化．同时测定相应阶段血β２－ＭＧ．结果降压期间ＣＯ，ＣＩ，ＳＶ，ＳＩ，ＣＶＰ，ＰＣＷＰ，ＲＶＳＷＩ，ＬＶＳＷＩ，ＳＰＡＰ，ＤＰＡＰ，ＭＰＡＰ，ＨＲ无显著性变化，ＳＶＲ，ＰＶＲ，Ｃｐｐ，Ｒｐｐ显著减少．降压前后血清β２－ＭＧ含量无变化．结论异氟醚控制性降压能维持良好的心肌氧供需平衡和心肌功能，对肾小球滤过率无明显影响．

Objective:To study effects of isoflurane-induced hypotension on hemodynamics and the changes of plasma β 2-Microglobulins during cerebral aneurysm operation.Method:Twenty-one cerebral anuerysm patients were operated under general anesthesia.Inalation concentration of isoflurane was elevated to reduce MAP 30%～40% during dissection and occlusion of the aneurysm.Changes in hemodynamics and plasma β 2-Microglobulins after deliberate hypotension with isoflurane were observed.Results:No significiant changes of CO,CI,SV,SI,LVSWI,RVSWI,CVP,PCWP,SPAP,DPAP,MPAP,HR and ECG tracing were observed during the period of hypotension (P>0.05).SVR,PVR,Cpp,Rpp were significiantly decreased during hypotension (P<0.05,or P<0.01),when the rish of myocardial ischemia and deoxygenation was not increased.No effect on the plasma β 2-Microglobulins was observed during hypotension induced by isoflurane in patients undergoing cerebral aneurysm cling operation.Conclusion:Hypotension reduced by isoflurane during cerebral aneurysm operation is able to keep a good balance between myocardial oxygen delivery and consumption and maintain good myocardial function.