安氟醚用于幕上肿瘤病人的颅内压、脑灌注压及动静脉氧压差影响  

Influences of Varied Concentrations of Enflurane on Intracranial Pressure, Cerebral Perfusion Pressure and Arteriovenous Oxygen Partial Pressure in Intracranial Tumor Surgery

作　　者：王志刚[1] 赵鑫[1] 王丹[1] 王晓雷[1] 孙国勇[1] 

机构地区：[1]山东大学第二医院麻醉科,中国济南250033

出　　处：《中国麻醉与镇痛》2005年第2期92-95,共4页China Anesthesia and Analgesia

摘　　要：目的：观察不同浓度安氟醚对颅内占位病变病人颅内压（ICP）、脑灌注压（CPP）和动静脉氧含量差（A-VDO2）的影响。方法：选择60例脑内幕上肿瘤行择期开颅手术病人。ASAⅠ-Ⅱ级、格拉斯哥评分15分。随机分为1％安氟醚（Ⅰ组）20例；2％安氟醚（Ⅱ组）20例和异丙酚组（Ⅲ组）20例。咪唑安定、哌库溴铵、芬太尼诱导氟管内插管，控制呼吸。保持PetCO2在4.0—4．4kPa。维持麻醉在Ⅰ组和Ⅱ组吸入安氟醚。Ⅲ组用微量泵持续翰注异丙酚5—8mg／（kg·h）。在显露硬脑膜前调整Ⅰ组和Ⅱ组的安氟醚吸入浓度．使Ⅰ组安氟醚呼出气浓度为1％．Ⅱ组安氟醚呼出气浓度为2％。显露硬脑膜后暂先不予剪开，由手术医生用22G穿刺针刺入硬脑膜下，连接压力换能器与监测仪．记录ICP数据，此为a时点。同时抽取桡动脉血和颈静脉球血各2ml，记录桡动脉平均压（MAP）。继以每隔5min记录一次ICP、MAP和抽取桡动脉血和颈静脉球血各2m1．前后共三次分别记为b、c、d时点。各时点抽取的血标本分别进行血气分析；监测PaCO2、PO2、pH、SpO2、Hb；计算动静脉血氧含量（A-VD02）；计算脑灌注压（CPP）。结果：1％安氟醚组、2％安氟醚组和异丙酚组的ICP、CPP、A-VDO2的组内、组间比较均无显着性差异。结论：吸入不超过2％的安氟醚对幕上肿瘤开颅手术病人的颅内压、脑灌注压、动静脉氧含量差无明显影响．效果满意。Objective To observe the influences of varied concentrations of enflurane on intracranial pressure （ICP）, cerebral perfusion pressure（CPP） and arteriovenous oxygen partial pressure （a-vDO2） in intracranial tumor surgery. Methods Sixty patients with ASA Ⅰ-Ⅱ and Glasgow score 15 undergoing intracranial tumor surgery were randomized to three groups： Group Ⅰ with 1% enflurane inhaled （n=20）; Group Ⅱ with 2% enflurane inhaled （n=20 ） and Group Ⅲ with propofol intravenous pumped as a rate of 5-8mg/（kg·h） （n=20）. General anesthesia induced with midazolam, fentanyl and vencuronium. Control ventilation maintained with PetCO2 ranged of 4.0-4.4kPa. The expired enflurane concentration was adjusted in 1% and 2% in group Ⅰ and Ⅱ respectively before the exposure of duramater. Use the fine needle penetrated into the sub-duramater space as 1mm in length by the surgeon and connected with the pressure transducer as to meassure the data of ICP. The centesis of radial artery and internal jugular vein were made as to monitor the direct blood pressure （MAP） and to collect two milliliter of radial artery blood sample and jugular bulb vein blood sample respectively as to meassure the blood gas analysis （as certain of time-point a）. Where after at the 5 minute, 10 minute and 15 minute （as certain of time-point b, c and d） another two milliliter of arterial blood sample and jugular bulb vein blood sample respectively were collected. The a-vDO2 and CPP were calculated by the formula. Results No significant difference in ICP、 CPP and a-vDO2 between the 1% enflurane group, 2% enflurane group and propofol group. Conclusion Inhalation the enflurane within the concentration of 2% is available on the stability of ICP、CPP and a-vDO2 in patients undergoing intracranial tumor operation and maintain satisfactory on the balance of brain oxygen supply and demand.

关 键 词：二异丙酚 安氟烷 颇内压 脑灌注压 支静脉氧含量差 幕上肿瘤 安氟醚 肿瘤病人 动静脉 颅内压 

分 类 号：R651.15[医药卫生—外科学] R739.41[医药卫生—临床医学]