七氟醚控制性降压用于颅脑手术对围术期患者血流动力学和脑氧代谢的影响

Effects of controlled hypotension with sevoflurane on hymodynamics and cerebral metabolic rate of oxy-gen in neurosurgery

目的研究七氟醚控制性降压用于颅脑手术对围术期血流动力学和脑氧代谢的影响。方法选择择期颅脑手术患者37例,ASA I或II级,在全身麻醉后,随机分为两组,分别给予七氟醚(S组,n=20)和硝普钠(N组,n=17)行控制性降压。监测术中HR、BP、SpO2、ECG,桡动脉、右颈内动脉球部抽血标本行血气分析,计算颈内静脉球部血氧含量差(Da-jvO2)、脑氧代谢率(CMRO2)、心率收缩压乘积(RPP)。结果 S组在降压达到目标MAP时,各时点的HR明显慢于N组(P<0.05)。两组Da-jvO2、CMRO2在降压时均下降(P<0.05),但两组差异无统计学意义。S组RPP在降压期间明显低于N组(P<0.05)。结论七氟醚控制性降压更能稳定血流动力学状态,同时改善脑氧代谢。

Objective To study the effects of controlled hypotension with sevoflurane on hymo-dynamics and cerebral metabolic rate of oxygen in neurosurgery.Methods Thirty-seven ASA Ⅰ or Ⅱpatients undergoing elective intracranial surgery were enrolled.The patients were treated with general anesthesia and assigned to two experimental groups,sevoflurane group （group S,n=20）and sodium nitroprusside group （group N,n=1 7）.HR,BP,SpO2 and ECG were continuously monitored during operation.Blood samples were taken from radial artery and internal jugular bulb to determine cerebral arteriovenous oxygen differences （Da-jvO2 ） and cerebral metabolic rate of oxygen （CMRO2 ）. Results The HR in group S were decreased during hypotension,5 min,10 min,20 min,and 30 min compared with group N （P 〈0.05）.Da-jvO2 and CMRO2 both in two groups were decreased during hypotension（P 〈 0.05 ）,but there was no difference between the two groups.RPP was lower in group S than in group N during hypotension.Conclusion Controlled hypotension with sevoflurane does not increase HR and improves cerebral blood flow-metabolism coupling.