地氟醚麻醉用于颅内手术的临床观察

Desflurane Anesthesia Used in Patients undergoing Intracranial Operations

目的：探讨地氟醚麻醉用于颅内手术时颅内压的改变。方法：１６例颞叶肿瘤择期手术病人，麻醉诱导气管内插管后，吸入１ＭＡＣ地氟醚维持，监测并记录麻醉前、诱导中、麻醉后２０、３０、４０、５０分钟的脑脊液压力（ＣＳＦＰ）、ＭＡＰ和ＰＥＴＣＯ２的变化。结果：在ＰＥＴＣＯ２维持２８～３１ｍｍＨｇ水平的条件下，全麻诱导期ＣＳＦＰ、ＭＡＰ明显下降（Ｐ＜０．０１）。吸入１ＭＡＣ地氟醚后ＣＳＦＰ逐渐上升；但５０分钟后仍低于麻醉前水平，ＭＡＰ明显低于麻醉前（Ｐ＜０．０１）。结论：神经外科手术应用异丙酚诱导，ＰＥＴＣＯ２保持在２８～３０ｍｍＨｇ，吸入１ＭＡＣ地氟醚维持麻醉不增加颅内压。

Objective:To investigate the appropriateness of desflurane anesthesia used in patients undergoing intracranial operations. Metheds: Sixteen patients were scheduled for removal of supratentorial mass. A radial artery catheter and a subarachanoid catheter were placed respectively prior to induetion of anesthesia. MAP, cerebrospinal pressure (CSFP), PETCO2 and HR were monitored. Anesthesia was induced with intravenous midazolan, fentanyl, propofol and vecuronium. After endotracheal intubation, anesthesia was maintained by desfurane inhalation in a concentration of 6% (IMAC) throughout the operation. MAP, CSFP and PET CO2 were recorded before and during induction, at 20min, 30min, 40min and 50min during desflurane inhalation. Results: Compared with the baseline data recorded before anesthesia, CSFP and MAP were decreased significantly during induction. The CSFP tended to increase at 20 min after inhalation of 6% desflurane, but remained below the baseline till 50min. MAP was decreased following inhalation of 6% desflurane and kept relatively stable thereafter. No significnt change in HR was noted. Conclusion: under the condition of PETCO28-30mmHg, 1MAC desflurane anesthesia can be used safely without any increase in ICP in patients undergoing intracranial operations.