异丙酚静脉麻醉对颅脑手术患者脑血流及代谢的影响

Effect of Propofol Anesthesia on Cerebral Blood Flow and Metabolism in Patients Undergoing Cranium Surgery

目的:观察颅脑手术患者应用异丙酚静脉麻醉对脑血流及代谢的影响。方法:选择全麻开颅肿瘤切除术病人27例,行颈内静脉逆行插管,切开硬脑膜后,随机分成两组。Ⅰ组吸入0.8～1.3最低肺泡麻醉药浓度(MAC)的异氟醚。Ⅱ组静注异丙酚100～150μg/(kg·min)。监测脉搏氧饱和度(SaO_2)、潮气末二氧化碳分压(P_(ET)CO_2)、颅内压(ICP)和桡动脉、颈内静脉血气,计算脑动静脉氧含量差(Da-jvO_2=CaO_2-CjvO_2)脑氧摄取(CEO_2=SaO_2-SjvO_2)。结果:两组颅内压(ICP)变化不明显,而平均动脉压(MAP)和脑灌注压(CPP=MAP-ICP)均有明显的降低(P<0.05)。吸入异氟醚后,颈静脉饱和度(SjvO_2)增加4.5％,而Da-jvO_2和CEO_2分别下降10.5％和7.8％;静注异丙酚后,SjvO_2降低5.3％,而Da-jvO_2和CEO_2分别增加19.2％和18.9％。结论:异丙酚静脉麻醉可降低脑需氧量,减少脑血流,并可保持脑血流(CBF)与脑氧代谢率(CMRO_2)的良好匹配,适用于颅脑手术麻醉。

To evaluate the effect of propofol intravenous anesthesia on cerebral blood flow and metabolism in patients undergoing brain surgery. Methdos: Twenty-seven patients who received general anesthesia and retro-grade jugular venous catheterization were randomly divided into two groups after dura mater incision. 0.8 to 1.3 MAC isofluren was inhaled in group 1. Propofol was administrated intravenously in group 2 at the dosage of 100-500 μg/(kg-min). SpO2, PErCO2, ICP, and blood gas parameters of radial artery and internal jugular vein were monitored. Cerebral arteriovenous difference of oxygen (Da-jvO2 = CaO2 - CjvO2) and cerebral extraction of oxygen (CEO2 = SaO2 - SjvO2) were calculated and analyzed. Results: In the two groups, ICP changed little, but MAP and CPP decreased markedly (P<0.05). In isofluren group, SjvO2 increased by 4.5% , Da-jvO2 and CEQ2 decreased by 10.5% and 7.8% respectively. In propofol group, SjvO2 decreased by 5.3% , Da-vOz by 19.2% , and CEOj by 18.9%. Conclusion: Propofol intravenous anesthesia can decrease cerebral oxygen consumption and cerebral blood flow, and maintain a good match between CBF and CMRO2 . It is suitable to cranium surgery anesthesia.