不同浓度七氟醚对颅内压的影响

Effects of sevoflurane at different concentration on intracranial pressure

目的研究0.5MAC、1.0MAC和1.5MAC七氟醚对颅内压(ICP)的影响,并与异氟醚相比较。方法选择60例择期行大脑半球胶质瘤切除术的患者按简单随机法分为异氟醚(I)组和七氟醚(S)组,每组30例,每组再随机分为0.5MAC组、1.0MAC组和1.5MAC组,每组10例。全麻诱导前行L3-4穿刺置管测脑脊液压(CSFP)代替ICP;右颈内静脉穿刺置管测中心静脉压(CVP);右桡动脉穿刺置管测平均动脉压(MAP)。全麻诱导方案相同,诱导后分别吸入异氟醚或七氟醚,并于麻醉诱导前、异氟醚或七氟醚达预定呼气末浓度即刻、15m in、30m in时观察并记录MAP、CVP和ICP。结果七氟醚对ICP的影响呈剂量相关性增加,无论七氟醚或异氟醚,1.5MAC组的ICP与麻醉前基础值比较具有统计学意义(P<0.05);相同MAC值的七氟醚与异氟醚增加ICP的作用比较无统计学意义(P>0.05)。结论七氟醚对ICP的影响与异氟醚相似,呈剂量依赖性增加ICP,超过1.5MAC的七氟醚增加ICP尤为明显。

Objective To investigate the effects of sevoflurane at different concentration of 0.5MAC,1.0MAC and 1.5MAC on intracranial pressure and to compare the effects with isoflurane.Methods 60 patients who received supratentorial glioma operation were randomly divided into group isoflurane and group sevoflurane,two groups were randomly given 0.5 MAC,1.0 MAC or 1.5MAC isoflurane and sevoflurane respectively after anesthetic induction.Measurements included cerebrospinal fluid pressure（CSFP）;mean arterial pressure（MAP） and central venous pressure（CVP）.CSFP reflecting ICP was estimated through a 17G epidural catheter inserted in the subarachnoid space under local anesthesia at L3-4 interspace.All the measurements were taken before anesthetic induction and at the time of 0,15 and 30 minutes when expire end concentration of isoflurane or sevoflurane reached the preset goal.Results ICP was increased in a dose-response manner during sevoflurane inhalation.ICP which was increased by sevoflurane or isoflurane at 1.5MAC were significantly higher than pre-anesthetic level（P〈0.05）.There were no significant difference in ICP between sevoflurane and isoflurane at the same MAC.Conclusion ICP is increased in a dose-response manner during sevoflurane inhalation.Inhalation of sevoflurane beyond 1.5 MAC can increase ICP remarkably.These changes were similar to isoflurane.