不同浓度地氟醚对脑动脉瘤患者收缩和舒张脑血管物质的影响  

Effects of different concentrations of desflurane on cerebral vascular contracting and relaxing factors in plasma during craniotomy and aneurysm clipping

作　　者：罗芳[1] 彭昆[1] 王恩真[1] 张淑珍[1] 王保国[1] 单若明[2] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100050 [2]首都医科大学中心实验室

出　　处：《临床麻醉学杂志》2005年第3期171-173,共3页Journal of Clinical Anesthesiology

基　　金：北京市自然科学基金课题(7992021)

摘　　要：目的　比较不同浓度地氟醚对颅内动脉瘤夹闭术患者血管紧张素I(AT Ⅰ)、血管紧 张素Ⅱ(AT Ⅱ)、内皮素(ET)和降钙素基因相关肽(CGRP)的影响。方法　择期开颅动脉瘤夹闭术 患者45例,随机分为地氟醚1.0MAC组(Ⅰ组)、1.3MAC组(Ⅱ组)、1.5MAC组(Ⅲ组)三组,每组 15例,麻醉诱导后气管插管控制呼吸,术中地氟醚MAC分别维持在1.0、1.3和1.5。分别于麻醉诱 导前(T1)、剪硬膜(T2)、夹闭动脉瘤(T3)和动脉瘤夹闭后30min(T4)四个时点采集动脉血,应用放 免法检测血浆中AT Ⅰ、AT Ⅱ、ET和CGRP的浓度。结果　三组ET于T2、T3和T4较T1时均明 显降低(P<0.05),但组间比较差异无显著意义(P>0.05)。三组AT Ⅰ、AT Ⅱ和CGRP组内及组 间比较差异均无显著意义(P>0.05)。结论　颅内动脉瘤夹闭术中,1.0、1.3和1.5MAC地氟醚均 可降低ET浓度,可能预防术中急性脑血管痉挛的发生。Objective To observe the alterations of angiotensin Ⅰ (AT-Ⅰ),angiotensin Ⅱ(AT-Ⅱ),endothelin (ET),and calcitonin gene-related peptide (CGRP)during different concentrations of desflurane anesthesia in patients undergoing craniotomy and aneurysm clipping.Methods Forty-five patients scheduled for elective craniotomy and aneurysm clipping were divided into three groups randomly and equally.Anesthesia was induced with propofol,fentanyl,and vecuronium and maintained with desflurane (MAC=1.0,1.3 and 1.5,respectively).Plasma concentrations of AT-Ⅰ,AT-Ⅱ,ET,and CGRP were measured with radioimmunoassay before induction (T 1),during dura opening (T 2),during aneurysm clipping (T 3),and at 30 min after aneurysm clipping (T 4) respectively.Results ET decreased significantly at T 2,T 3,and T 4 compared with that at T 1 in each group(P<0.05).No significant difference was found in ET among the three groups (P>0.05).There was no significant difference in AT-Ⅰ,AT-Ⅱ,and CGRP during anesthesia compared with those at the baseline in each group and among the three groups (P>0.05).Conclusion Desflurane anesthesia can prevent acute cerebral vasospasm caused by ET in patients undergoing craniotomy and aneurysm clipping.

关 键 词：地氟醚 脑动脉瘤 血管紧张素Ⅰ 血管紧张素Ⅱ 内皮素 

分 类 号：R614[医药卫生—麻醉学]