不同麻醉诱导方式对室间隔缺损婴儿脑血流及脑电的影响

Effects of different anesthesia induction schemes on cerebral hemodynamics and electroencephalogram activity in infacts with ventricular septal defect

目的:比较不同麻醉诱导方法下潮气末二氧化碳分压对行室间隔缺损修补术的婴儿脑血流动力学和脑电SEF的影响。方法:将择期在体外循环下行室间隔缺损修补术的90例婴儿分为静脉麻醉组(SM组)和吸入麻醉组(S组)。SM组依次给予咪达唑仑、哌库溴铵、舒芬太尼。S组吸入七氟烷(1.5~2.0Mac)、哌库溴铵。行气管插管,调整呼吸参数使PetCO_(2)依次维持在30mmHg(1mmHg=0.133 kPa,T1)、35mmHg(T2)、40mmHg(T3)、45mmHg(T4),分别记录SEF、rScO_(2)、CBFV、HR、SBP、DBP、CI等。结果:T1~T4过程中,两组rScO_(2)、CBFV收缩、CBFV舒张、CBFV平均升高(P<0.01)。S组rScO_(2)、SEF高于SM组(P<0.01);S组脑血流速度高于SM组(CBFV平均:T2、T3、T4,P<0.01;CBFV舒张:T4,P<0.05)。S组各点SBP、DBP、CI均低于SM组(P<0.01),HR均高于SM组(P<0.01)。相关性:两组SEF左、SEF右与CBFV呈正相关(P<0.01);S组SEF左、SEF右与rScO_(2)均呈正相关(P<0.01),SM组SEF右与rScO_(2)呈正相关。结论:室间隔缺损婴儿在麻醉诱导期间,脑灌注随PetCO_(2)升高而增加,这一作用在七氟烷吸入麻醉下更明显。与静脉复合麻醉相比,七氟烷吸入麻醉婴儿的脑血流动力学更优,脑电SEF更活跃。

Objective:To compare the different effects of Sevoflurane inhalation anesthesia induction and Midazolam-Sufentanyl intravenous anesthesia induction on cerebral hemodynamics and spectral edge frequency(SEF)of EEG in infants with ventricular septal defect(VSD)undergoing cardiac surgery.Methods:The infants were randomly assigned to receive either Sevoflurane(S group)or Sufentanyl、Midazolam intravenous anesthesia(SM group).Midazolam、pipecuronium、Sufentanyl were given in the SM group,Sevoflurane(1.5-2.0Mac)、pipecuronium were given in the S group.After intubation,end-tidal carbon dioxide(PetCO_(2))levels of 30 mmHg(1mmHg=0.133kPa,T1)、35 mmHg(T2)、40 mmHg(T3)、45 mmHg(T4)were obtained by adjusting the tidal volume(VT)and respiratory rate(RR).SEF、regional cerebral oxygen saturation(rScO_(2))、cerebral blood flow velocity(CBFV)、heart rate(HR)、SBP、DBP、cardiac index(CI)were recorded at each time point.Results:As PetCO_(2) increased from T1 to T4,rScO_(2)、CBFVsystolic、CBFVdiastolic、CBFVmean increased significantly(P<0.01)in both S group and SM group.rScO_(2)、SEF in the S group was higher compared to the SM group at each time point.CBFV in the S group was higher compared to the SM group.(CBFVmean:T2、T3、T4,P<0.01;CBFVdiastolic:T4,P<0.05)SBP、DBP、CI were lower in the S group at each time point compared with the SM group,while HR was higher.During T1 to T4,EEG SEF was positively correlated with CBFV(CBFVsystolic,CBFVdiastolic and CBFVmean)in both groups.In the S group,EEG SEF was positively correlated with rScO_(2),whereas only EEG SEFright was positively correlated with rScO_(2) in the SM group.Conclusions:During anesthesia induction,as PetCO_(2) increased,cerebral hemodynamics also improved especially for sevoflurane inhalation anesthesia.Compared with Midazolam-Sufentanyl intravenous anesthesia induction,cerebral hemodynamics was better and SEF was more active in Sevoflurane inhalation anesthesia induction.