吸入麻醉药对眼部血流动力学的影响  

Effects of inhalation anesthetics on ophthalmic hemodynamics

作　　者：年阿兴[1] 王兰[2] 焦岿然[1] 杨文利[2] 张炳熙[1] 

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730 [2]首都医科大学附属北京同仁医院眼科超声诊断室,100730

出　　处：《北京医学》2005年第10期600-602,共3页Beijing Medical Journal

摘　　要：目的通过彩色多普勒成像仪(CDI)研究七氟醚和异氟醚对眼部血流动力学的影响。方法选择无明显眼部疾患的非头颈部手术的成年患者30例,随机分为七氟醚组(S组)和异氟醚组(I组),以异丙酚、阿曲库铵快速诱导插入喉罩,并分别吸入七氟醚和异氟醚,于麻醉前、七氟醚或异氟醚1.5最低肺泡有效浓度(MAC)维持20min后,用CDI观测双眼动脉(OA)、视网膜中央动脉(CRA)和睫状后动脉(PCAs)的收缩期峰流速(PSV)、舒张期末流速(EDV)、平均流速(Tamx)和阻力指数(RI),测量眼压、体循环血压和心率。结果OA:S组的EDV及I组各参数在麻醉前后均无明显变化,S组其他参数小于麻醉前,两组各参数比较无明显差别。CRA:S组的PSV和Tamx显著小于麻醉前,EDV和RI无明显变化;I组的PSV、EDV和Tamx显著小于麻醉前,RI无明显改变;S组的PSV和Tamx明显高于I组,但EDV和RI无明显变化。PCAs:S组EDV无显著变化,其他参数及I组所有参数均明显小于麻醉前,S组的PSV、EDV和Tamx均显著大于I组,但RI无明显变化。麻醉后,舒张压与CRA和PCAs的PSV和EDV正相关,与RI负相关,但与OA各参数相关性不大。结论异氟醚和七氟醚均可显著改变眼部血流状态,尤其可降低CRA血供,但异氟醚作用更强。全麻状态下,舒张压与眼底血供有关。Objective To investigate the effects of sevoflurane and isoflurane on ocular hemodynamics by Colored Doppler imaging（CDI）. Methods 30 patients without eye diseases undergoing non-head and non-neck surgical procedures were enrolled in this study. They were randomized into sevoflurane group （S） or isoflurane group（Ⅰ）. Anesthesia was induced with intravenous propofol and atracuronium, followed by laryngeal mask insertion, and was maintained with isoflurane or isoflurane respcectively. Peak systolic velocity （PSV）, end diastolic velocity （EDV）, time average peak velocity （Tamx） and resistant index （RI） of bilateral ophthalmic artery（OA）, central retinal artery（CRA） and posterior ciliary arteries（PCAs） were determined by CDI before anesthesia and 20 min following inhalation of 1.5MAC. Blood pressure, heart rate and SpO2 were also recorded. Results OA： No significant changes was found in EDV of S group and all above parameters of Ⅰ group after anesthesia and the comparison between the two groups in all parameters showed no difference after anesthesia. However, the other parameters of S group were lower than before anesthesia. CRA： PSV and EDV were lower than before anesthesia in S group, in spite of no difference in EDV and RI. PSV, EDV and Tamx were higher in S group than those in Ⅰ group but no significant change in EDV and RI between the two groups was detected. FCAs： Except no changes in EDV, other parameters in the two groups were significantly lower after anesthesia. PSV, EDV and Tamx were significantly higher in S group than those in Ⅰ group, disregarding no difference in RI. Systemic diastolic pressure was positively correlated with PSV and EDV of both CRA and PCAs, negatively with RI. No relationship was found between diastolic pressure and parameters of OA. Conclusions Both sevoflurane and isoflurane can change ocular hemodynamics significantly, especially decreasing blood volume in CRA where isoflurane acts more powerfully. On the other hand, diastolic pr

关 键 词：异氟醚 七氟醚 眼血流动力学 眼部血流动力学 吸入麻醉 阻力指数(RI) 最低肺泡有效浓度 视网膜中央动脉 麻醉前后 药对 

分 类 号：R614[医药卫生—麻醉学]