摘要
目的观察瑞芬太尼复合七氟醚控制性降压对神经外科手术患者脑氧代谢的影响。方法选择拟行控制性降压的神经外科手术患者60例,随机均分为三组:R1组为瑞芬太尼3ng/ml复合七氟醚组,瑞芬太尼效应室靶浓度设定为3ng/ml;R2组为瑞芬太尼6ng/ml复合七氟醚组,瑞芬太尼效应室靶浓度设定为6ng/ml;N组为硝普钠组。R1、R2组同时吸入七氟醚,控制七氟醚呼出气浓度为1MAC,N组泵注硝普钠的速率为1～3μg·kg-1·min-1。记录麻醉前10min(T0)、降压后10min(T1)、30min(T2)、停止降压10min(T3)、30min(T4)时的MAP和HR,采集相应时点的颈内静脉血和动脉血作血气分析,计算动脉血氧含量(CaO2)、颈内静脉球部血氧含量(CjvO2)、脑动-静脉血氧含量差(Da-jvO2)、脑氧摄取率(CERO2)。结果 T1～T4时R1、R2组,T1、T2时N组MAP明显低于T0时(P<0.01),T2时R2组MAP明显低于N组和R1组(P<0.05或P<0.01)。T1～T4时N组HR明显快于T0时和R1、R2组(P<0.01),T1～T3时R1、R2组HR明显慢于T0时,而T2时R2组HR明显慢于R1组(P<0.05或P<0.01)。T1～T4时三组CjvO2明显高于T0时(P<0.01),而Da-jvO2与CERO2明显低于T0时(P<0.01),T1、T2时R1、R2组CjvO2高于N组(P<0.05),而Da-jvO2与CERO2低于N组(P<0.05)。结论瑞芬太尼复合七氟醚控制性降压可降低神经外科手术患者的脑氧代谢,降压平稳迅速,HR缓慢,停止降压后无BP反跳现象,有利于围术期脑保护。
Objective To investigate the effect of remifentanil combined with sevoflurane on cerebral oxygen metabolism during controlled hypotension in neurosugery. Methods Sixty patients undergoing selective neurosugery were randomly divided into group R1 ,group R2 and group N （n=20 each）. Group R1 and R2 were subjected to target-controlled infusion of remifentanil which is based on the plasma compartment concentration （R1：3 ng/ml; R2：6 ng/ml） and sevoflurane （concentration of expired gas was 1 MAC）. Group N were infused with SNP 1-3μg.kg-1 .min-1 for controlled hypotension. At the moment of 10 min before anesthesia （T0）, 10 min（T1 ） and 30 min（T2） after controlled hypotension, 10 min（T3 ） and 30 min（T4 ） after end of controlled hypotension, MAP and HR were recorded and blood-gas analysis was performed after the blood was taken from radial artery and internal carotid vein. The oxygen saturation （CaO2）, jugular bulb venous oxygen content （CjvO2）, cerebral arterial to jugular venous oxygen content differences （Da-jvO2）, and the rate of cerebral 02 extraction （CERO2） were calculated. Results Compared with the MAP and HR value at moment of To, in three groups MAP were decreased significantly at T1 and T2 and MAP in group R1 and R2 were decreased at TO and T4 （P%0. 01）. HR in group R1 and R1 was lower at T1 and T2than that in group N respectively（P〈0.01）. However, MAP and HR in group R2 was lower than those in group R1 （P%0. 05）. In group R1 and R2, compared with the CjvO2 at the moment of To, the values at the moment of T1, T2, TO or T4 increased significantly while decreased significantly as compared to the Da-jvO2 and CERO2 at the moment of To （P〈0.01）. The CjvO2 in group R1 and R2 were higher at T1 and T2 than that in group N while the Da-jvO2 and CERO2 were lower at T1 and T2 than those in group N（P〈0. 05）. The CjvO2, Da-jvO2 and CERO2 value were no obvious difference between group R1 and R2. Conclusion Remifentanil combined with sevoflurane cou
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2012年第2期118-121,共4页
Journal of Clinical Anesthesiology
关键词
瑞芬太尼
七氟醚
控制性降压
神经外科
脑氧代谢
Remifentanil
Sevoflurane
Controlled hypotension
Neurosurgery
Cerebral oxygen metabolism
