异丙酚-芬太尼麻醉下妇科腹腔镜手术患者脑葡萄糖与氧代谢的变化  

Changes in cerebral oxygen delivery/consumption and glucose metabolism during laparoscopic gynecologic surgery under propofol-fentanyl anesthesia

作　　者：徐世元[1] 侯景利[1] 许平[1] 叶小平[1] 梁启波[1] 曾繁荣[1] 

机构地区：[1]南方医科大学珠江医院麻醉科,广州市510282

出　　处：《中华麻醉学杂志》2005年第11期811-813,共3页Chinese Journal of Anesthesiology

摘　　要：目的研究异丙酚-芬太尼麻醉下妇科腹腔镜手术患者脑葡萄糖及氧代谢的变化。方法 15例拟行妇科腹腔镜手术患者,ASA Ⅰ或Ⅱ级,年龄20-59岁,体重47-65 kg,静脉注射芬太尼2 μg·kg-1、维库溴铵0．1 mg·kg-1、异丙酚2 mg·kg-1行麻醉诱导;靶控输注(效应室靶浓度为3-4μg· ml-1)异丙酚及间断追加维库溴铵、芬太尼维持麻醉。气腹后立即取头低足高位,分别于麻醉前(T1)、气腹前(T2)、气腹10 min(T3)、20 min(T4)及60 min(T5)时采集桡动脉及颈内静脉球部血,行血气分析及血糖、乳酸测定,同时测定上述各时间点颈内静脉球部压力(JBP)。结果与T2相比,T3-5时JBP、颈内静脉球部血氧饱和度升高,脑动、静脉血氧浓度差及脑氧摄取率降低;与T3比较,T5时动脉血糖浓度、颈内静脉血糖浓度升高,脑动、静脉血糖浓度差、葡萄糖摄取率及脑动、静脉乳酸浓度差差异无统计学意义。结论异丙酚全凭静脉麻醉下妇科头低足高位腹腔镜手术时JBP升高,血糖水平升高,氧供大于氧耗,但脑氧及葡萄糖代谢不受影响。Objective To evaluate the changes in cerebral oxygen delivery/consumption and glucose metabolism during laparoscopic gynecologic surgery under propofol-fentanyl anesthesia. Methods Fifteen ASA Ⅰ or Ⅱ patients aged 20-59 yrs weighing 47-65 kg undergoing laparoscopic gynecologic surgery under propofol-fentanyl anesthesia were studied. The patients were premedicated with scopolamine 0.3 mg, midazolam 0.02 mg·kg^-1 and fentanyl-droperidol mixture 0.03 ml·kg^-1 Ⅳ. Anesthesia was induced with fentanyl 2 μg·kg^-1 , propofol 2 mg·kg^-1 and vecuronium 0. 1 mg·kg^-1 and maintained with TCI of propofol with target effect-site concentration set at 3-4 μg·ml^-1 and intermittent IV boluses of fentanyl and vecuronium. The patients were mechanically ventilated （VT=7ml·kg^-1 RR= 14 bpm, I：E= 1：2）. PETCO2 was maintained at 35-45 mm Hg. Radial artery was cannulated for BP monitoring and blood sampling. Left internal jugular vein was cannulated and advanced cephalad until a resistance was met. The depth of insertion was about 11-14 cm. After the pneumoperitoneum was established （intra-abdominal pressure = 15 mm Hg）, the patients were placed in head-down position. Blood samples were taken from radial artery and internal jugular vein simultaneously before anesthesia （ T1 , baseline）, before pneumoperitoneum （T2） and at 10, 20 and 60 min after pneumoperitoneum was established （T3-5） for blood gas analysis and determination of plasma glucose and lactic acid concentration. Arterio-jugular oxygen content difference（ Da-jvO2 ）, arterio-jugular plasma lactic acid difference （ Da-jv Lac ）, cerebral oxygen consumption and cerebral glucose extraction rate （GluER） were calculated. Jugular bulb pressure （JBP） was recorded at blood sampling. Results After pneumoperitoneum was established JBP increased significantly. Jugular bulb oxygen saturation （Sjv O2 ） increased significantly. Da-jv O2 and cerebral oxygen extraction rate （OER） decreased significantly after pneumoperitoneum （ T

关 键 词：二异丙酚 腹腔镜检查 脑 葡萄糖 氧耗量 

分 类 号：R614[医药卫生—麻醉学]