4种不同麻醉药物对大脑中动脉血流速率的影响机制研究

Study on impact mechanism of four different anesthetics on middle cerebral artery blood flow velocity

目的比较4种不同麻醉药物在麻醉诱导期间对大脑中动脉血流速率的影响。方法 80例患者按随机数字表法随机分为4组,每组20例,麻醉维持药物分别为丙泊酚2.00mg/kg、依托咪酯0.30mg/kg、咪达唑仑0.15mg/kg和地佐辛0.20mg/kg,脑电双频指数(BIS)值降至50以下行气管插管及机械通气。采用经颅多普勒脑血流监测仪(TCD),监测并记录4组患者入室后诱导前(T0)、插管前1min(T1)、插管时(T2)、插管后1min(T3)、插管后3min(T4)、插管后5min(T5)大脑中动脉平均血流速率(Vm-MCA)、平均动脉压(MAP)、心率(HR)、收缩压(SBP)、舒张压(DBP)。结果除咪达唑仑组外,其他3组T1时VmMCA均明显降低于T0(P<0.05);插管后,咪达唑仑组和依托咪酯组的Vm-MCA、SBP、DBP与基础值相比显著升高,丙泊酚组和地佐辛组则差异无统计学意义(P>0.05)。结论咪达唑仑和依托咪酯在对气管插管引起的大脑中动脉血流速率波动的抑制较丙泊酚和地佐辛弱。

Objective To compare the impacts of four different intravenous anesthetic agents on middle cerebral artery blood flow velocity（V-MCA） during the anesthesia induction period. Methods Totally 80 cases were randomly divided into four groups （n = 20）, maintenance drugs of anesthesia were propofol 2.00 mg/kg, etomidate 0.30 mg/kg, midazolam 0.15 mg/kg and dezoeine 0.20 mg/kg respectively,the bispectral index （BIS） value was dropping to below 50, the endotracheal intubation and mechanical ventilation were performed. The transcranial Doppler （TCD） monitoring was adopted to monitor and record middle cerebral artery mean flow velocity （Vm-MCA）, mean arterial pressure （MAP）, heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP） in the four groups before induction after entering operation room （T0）,at1 min before intubation （T1）,immediate intubation （T2）,at 1 rain after intubation （T3）,3 rain after intubation （T4）, 5 rain after intubation （T5）. Results Except for the midazolam group,Vm-MCA at T1 in the other three groups were significantly lower that that in the T0 group （P〈0.05）;VmMCA,SBP,DBP after intubation in the midazolam group and the etomidate group were significantly increased compared with the basic values, while the difference between the propofol group and the dezocine group had no statistical significance （P〉0.05）. Conclusion midazolam and etomidate are weaker than propofol and dezocine in the aspect of inhibiting the middle cerebral arterial blood flow fluctuations caused by intubation.