七氟醚-瑞芬太尼麻醉对缺血型烟雾病脑血管重建术患者脑氧供需平衡的影响

Effects of sevoflurane-remifentanil anesthesia on the balance between cerebral oxygen supply and demand during cerebral revascularizafion for ischemic moyamoya disease

目的评价七氟醚，瑞芬太尼麻醉对缺血型烟雾病脑血管重建术患者脑氧供需平衡的影响。方法择期行颞浅动脉-大脑中动脉分支吻合术的缺血型烟雾病患者40例，性别不限，年龄19～59岁，BMI 19～25kg／m2，ASA分级Ⅰ或Ⅱ级，Suzuki分期≥3。采用随机数字表法，将患者随机分为2组（n=20）：异丙酚-瑞芬太尼组（PR组）和七氟醚-瑞芬太尼组（SR组）。麻醉诱导：靶控输注异丙酚，血浆靶浓度5μg／ml，静脉注射芬太尼3μg／kg和罗库溴铵0．6mg／kg。气管插管后行机械通气，麻醉维持：SR组吸人七氟醚（呼气末浓度1．0％～1．7％），PR组TCI异丙酚，血浆靶浓度3～4μg／ml，2组均TCI瑞芬太尼，血浆靶浓度3．5ng／ml，维持BIS值40～60，间断静脉注射罗库溴铵0．3mg／kg。分别于麻醉诱导前（Tn）、血管阻断前10min（T1）、血管阻断后10min（T2）、血管吻合,开放后10min（T3）时记录局部脑氧饱和度（rSO2）。结果与T0时比较，PR组T3时术侧rSO2升高，SR组T1-3时术侧和非术侧rSO2升高（P〈0．05或0．01）；与PR组比较，SR组T1时术侧rSO2升高（P〈0．05），非术侧rSO2差异无统计学意义（P〉0．05）。结论对于缺血型烟雾病脑血管重建术患者，七氟醚复合瑞芬太尼麻醉可维持良好的脑氧供需平衡状态，且与异丙酚复合瑞芬太尼麻醉的效果相似。

Objective To evaluate the effects of sevoflurane-remifentanil anesthesia on the balance be- tween cerebral oxygen supply and demand during cerebral revascularization for ischemic moyamoya disease by mon- itoring regional cerebral O2 saturation （ rSO2 ） with near infrared spectroscopy. Methods Forty patients of both sexes aged 19-59 yr with a body mass index of 19-25 kg/m2 undergoing superficial temporal artery-middle cerebral artery anastomosis were randomly allocated into 2 groups （n = 20 each）： propofol-remifentanil group （group PR） and sevoflurane-remifentanil group （group SR）. Radial artery was cannulated for direct BP monitoring and blood sampling. Near infrared spectroscopy probe was placed on the forehead. Anesthesia was induced with propofol TCI （Cp = 5 μg/ml）, fentanyl 3 μg/kg and rocuronium 0.6 mg/kg. The patients were mechanically ventilated after tra- cheal intubation （V_T 8-10 ml/kg, RR 10-12 bpm, I：E 1：2, FiO2 = 1.0）. P_ET CO2 was maintained at 35-40 mm Hg. Anesthesia was maintained with sevoflurane （end-tidal concentration 1 .0%-1.7% ） or propofol TCI （Cp = 3-4μg/ml） in combination with remifentanil TCI （Cp = 3.5 ng）ml） and intermittent iv boluses of rocuronium 0.3 mg/kg. BIS was maintained at 40-60 during operation, rSO2 was recorded before induction of anesthesia （T0 ）, 10 min before and 10 min after blood vessel was clamped （T1 , T2 ） and 10 min after anastomosis was completed（T3 ）. Results rSO2 was significantly increased on the operated side at T3 in PR group while in SR group bilateral rSO2 was significantly increased at T1-3 as compared with the baseline values at To （ P 〈 0.05 or 0.01 ）. rSO2 on the operated side was significantly higher at T1 in group SR than in PR group （ P 〈 0.05）. Conclusion The efficacy of sevoflurane-remifentanil anesthesia is similar to that of propofol-remifentanil anesthesia for revascularization for moyamoya disease in terms of maintence of the balance between cerebral oxygen supply and demand.