麻醉诱导方式对颅内肿瘤手术病人脑血流动力学及颅内压的影响

Effect of anesthesia induction on cerebral hemodynamics and intracranial pressure in patients undergoing intracranial tumor surgery

目的探讨异丙酚和咪唑安定诱导麻醉对颅内肿瘤手术病人脑血流动力学及颅内压(ICP)的影响。方法2016年1月至2019年1月开颅手术治疗颅内肿瘤100例,其中50例(对照组)诱导麻醉采用静脉注射咪唑安定(0.2 mg/kg)+舒芬太尼(0.3μg/kg)+顺苯磺酸阿曲库铵(0.2 mg/kg),50例(观察组)诱导麻醉采用静脉注射异丙酚(2 mg/kg)+舒芬太尼(0.3μg/kg)+顺苯磺酸阿曲库铵(0.2 mg/kg)。①麻醉诱导前、诱导后即刻、插管前、插管后2 min、插管后6 min及插管后10 min监测心率(HR)、收缩压(SBP)、舒张压(DBP)及ICP。②插管后5 min、切开硬膜、切除肿瘤后30 min、手术结束时及拔管时监测颈内静脉血氧饱和度(Sj⁃vO2)及脑动静脉血氧分压差(Da-jvO2)。结果①插管后6 min、插管后10 min,两组HR均明显降低(P<0.05);插管前两组SBP、DBP均明显降低(P<0.05)。插管后2 min,观察组SBP明显低于对照组(P<0.05)。两组ICP均无明显变化(P>0.05)。②观察组切开硬膜、切除肿瘤后30 min、手术结束时SjvO2水平较插管后5 min明显增高(P<0.05),而且观察组明显高于对照组。观察组切开硬膜、切除肿瘤后30 min、手术结束时Da-jvO2水平较插管后5 min明显降低(P<0.05),而且观察组明显低于对照组(P<0.05)。结论异丙酚与咪唑安定均对颅内肿瘤手术病人ICP无明显影响;但是可改善脑血流动力学,而且咪唑安定对SjvO2和Da-jvO2水平的改善明显优于异丙酚。

Objective To explore the effects of propofol-and midazolam-induced anesthesia on the cerebral hemodynamics and intracranial pressure(ICP)in the patients undergoing intracranial tumor surgery.Methods Of 100 patients with intracranial tumors who underwent surgery from January 2016 to January 2019,50 patients(control group)received anesthesia induced by intravenous injection of midazolam(0.2 mg/kg)+sufentanil(0.3μg/kg)+atracurium cissulfonate(0.2 mg/kg)and 50 patients(observation group)received intravenous propofol(2 mg/kg)+sufentanil(0.3μg/kg)+atracurium cissulfonate(0.2 mg/kg).The heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)and ICP were monitored before anesthesia induction,immediately after induction,before intubation,2 minutes after intubation,6 minutes after intubation,and 10 minutes after intubation.The jugular venous blood oxygen saturation(SjvO2)and cerebral arteriovenous blood oxygen partial pressure difference(Da-jvO2)were monitored at 5 minutes after intubation,incision of the dura,30 minutes after tumor resection,the end of surgery and the time of extubation.Results At 6 and 10 minutes after intubation,the HR was significantly reduced in both groups(P<0.05).The SBP and DBP were significantly reduced before intubation in both groups(P<0.05).The SBP in the observation group was significantly lower than that in the control group 2 minutes after intubation(P<0.05).There was no significant change in ICP in both groups(P>0.05).The SjvO2 levels at 30 minutes after incision of the dura mater,the tumor was removed and the end of the operation of the observation group were significantly higher than those of the control group(P<0.05).The level of Da-jvO2 at 5 minutes after intubation,30 minutes after the duratomy and tumor removal in the observation group was significantly lower than those in the control group(P<0.05).Conclusions Both propofol and midazolam have no significant effect on ICP in patients undergoing intracranial tumor surgery,but they can improve cerebral hemodynamics.Midazolam is significantly better than propofol in improvement of SjvO2 and Da-jvO2 levels.