丙泊酚靶控输注诱导气管插管对腹腔镜手术患者脑氧平衡及代谢的影响

Influence on cerebral oxygen balance and metabolism of propofol target controlled infusion induced tracheal intubation in patients with laparoscopic surgery

目的 探讨丙泊酚靶控输注诱导气管插管对腹腔镜手术患者脑氧平衡及代谢的影响.方法 选取2012年1月至2013年10月择期行妇科腹腔镜手术患者96例,所有患者均在丙泊酚靶控输注麻醉诱导下行颈内静脉逆行穿刺置管至右侧颈内静脉球部,行桡动脉置管.根据丙泊酚靶控输注的目标浓度分为A组32例、B组33例和C组31例,浓度分别为3,5,7μg/ml.监测患者手术过程中血流动力学及Nacotrend指数（NI）变化,分别于诱导前（T0）、插管即刻（T1）、插管后30 min（T2）、术毕（T3）收集患者颈内静脉和桡动脉血进行血气分析,比较三组患者不同时间点的动脉血氧分压（PaO2）、动脉血氧含量（CaO2）、颈内静脉球部血氧饱和度（SjvO2）、颈内静脉球部血氧分压（PjvO2）,计算三组动脉-颈内静脉球部血氧差（Da-jvO2）、脑氧摄取率（CEO2）、乳酸含量差（Da-jvL）.结果 三组患者收缩压、心率和NI在T1和T2时均明显低于To,差异有统计学意义（P＜0.05）,而三组患者T1、T2时的NI比较差异有统计学意义（P＜0.05）.与To比较,三组患者的PaO2、PjvO2、SjvO2和CaO2在T1～T3明显升高（P＜0.05）,且三组数值均以C组最高,B组次之,A组最低.在丙泊酚靶控输注过程中,Da-jvO2、CEO2和Da-jvL均呈现逐渐下降的趋势,其中以Da-jvL下降趋势最为明显,差异有统计学意义（P＜0.05）.结论 丙泊酚靶控输注诱导气管插管可降低腹腔镜手术患者的脑氧代谢速度,增加脑组织对缺血缺氧的耐受性,但并不会导致患者出现脑氧供需失衡,其中以7μg/ml丙泊酚浓度的麻醉效果最佳.

Objective To discuss the influence on cerebral oxygen balance and metabolism of propofol target controlled infusion induced tracheal intubation in patients with laparoscopic surgery.Methods A total of 96 patients with gynecologic laparoscopic surgery were selected from January 2012 to October 2013.All patients were in propofol target controlled infusion anesthesia induction downward internal jugular vein retrograde through jugular vein ball tube,radial artery catheter.According to propofol target controlled infusion target concentrations,96 patients were divided into A group （32 cases,3 μ g/ml）,B group （33 cases,5 μμg/ml） and C group （31 cases,7 μg/ml）.Hemodynamic and Nacotrend index （NI） change were monitored in the process of surgery patients,with internal jugular vein and radial artery blood at pre-induction （To）,intubation （T1）,30 min after intubation （T2） and the end of the operation （T3） were detected and arterial blood oxygen saturation （PaO2）,arterial oxygen content （CaO2）,internal jugular vein ball blood oxygen saturation （SjvO2）,internal jugular vein ball blood oxygen partial pressure （PjvO2） at different time points were compared among three groups.Artery-internal jugular vein ball low blood oxygen of components （Da-jvO2）,brain oxygen uptake rate （CEO2）,poor lactic acid content （Da-jvL） were calculated.Results The systolic blood pressure,heart rate and NI at T1,T2 was lower than that at To in three groups,and there was significant difference （P ＜ 0.05）,but there was significant difference in NI at T1,T2 among three groups （P ＜ 0.05）.Compared with T0,PaO2,PjvO2,SjvO2 and CaO2 at T1-T3 in three groups were increased significantly （P ＜ 0.05）,and the highest was C group,and then B group and A group.In the process of propofol target controlled infusion,Da-jvO2,CEO2 and Da-jvL showed a trend of gradual decline,Da-jvL decline highest significantly （P ＜ 0.05）.Conclusions Propofol target controlled infusion induced endotracheal intubation can decrease the laparoscopic surgery in patients with cerebral oxygen metabolism and the brain tissue of ischemia hypoxia tolerance,but will not lead to cerebral oxygen supply and demand imbalance,and 7 μ g/ml concentration of propofol anesthesia effect is the best.