异丙酚-芬太尼麻醉下颅内动脉瘤夹闭术中患者收缩和舒张脑血管物质的变化  

Changes in cerebral vaso- active substances in patients undergoing intracranial aneurysm clipping under propofol-fentanyl anesthesia

作　　者：罗芳[1] 张淑珍[1] 王恩真[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,100050

出　　处：《中华麻醉学杂志》2005年第11期817-819,共3页Chinese Journal of Anesthesiology

基　　金：北京市自然科学基金课题(7992021)

摘　　要：目的观察异丙酚-芬太尼麻醉下颅内动脉瘤夹闭术中患者血浆血管紧张素Ⅱ(AT Ⅱ)、内皮素(ET)和降钙素基因相关肽(CGRP)的变化。方法颅内动脉瘤破裂后2周择期行颅内动脉瘤夹闭术患者43例。静脉注射芬太尼2μg·kg-1、维库溴铵0．1 mg·kg-1、异丙酚2 mg·kg-1麻醉诱导后气管插管,持续输入异丙酚6 mg·kg-1·h-1维持麻醉,并间断追加芬太尼2 μg·kg-1和维库溴铵。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30 min(T4)时采集动脉血,应用放免法测定血浆AT-_Ⅱ、ET和CGRP的浓度,并监测平均动脉压(MAP)和心率(HR)。结果血浆AT-Ⅱ浓度和HR在各时间点比较差异无统计学意义(P>0．05),且均在正常范围内。与T1比较,血浆 CGRP和MAP在T2-4明显降低(P<0．05或0．01),但MAP仍在正常范围内。与T2比较,血浆ET浓度在T3时升高(P<0．05)。结论在异丙酚-芬太尼静脉麻醉下,动脉瘤夹闭术中患者血液中收缩血管的物质升高,舒张血管的物质降低,应注意预防急性脑血管痉挛的发生。Objective To determine the changes in angiotensin-Ⅱ （AT-Ⅱ）, endothelin （ET） and calcitonin gene-related peptide （CGRP） during intracranial aneurysm clipping performed under propofol-fentanyl anesthesia. Methods Forty-three patients of both sexes （20 male, 23 female） aged 19-64 yrs undergoing elective intracranial aneurysm clipping were studied. Anesthesia was induced with midazolam 0.05 mg·kg^-1 , fentanyl 2μg·kg^-1, propofol 2 mg·kg^-1 and vecuronium 0.1 mg·kg^-1 . The patients were intubated and mechanically ventilated. PETCO2 was maintained at 30-35 mm Hg. Anesthesia was maintained with propofol infusion at 6 mg·kg^-1 h^-1 and intermittent IV boluses of fentanyl. Esmolol 0.5 mg·kg^-1 was given IV whenever HR 〉 90 bpm and nicardipine 10 μg·kg^-1 when MAP increased by 20% of the baseline value. Radial artery was cannulated for continuous BP monitoring and blood sampling. MAP, ECG, HR, SpO2, PETCO2 and body temperature were continuously monitored during anesthesia. Blood samples were taken before induction of anesthesia （T1）, when dura was cut （T2）, when aneurysm was clipped （T3） and 30 min after clipping （T4） for determination of plasma concentrations of AT- Ⅱ , ET and CGRP by radioimmuno-assay. Results Plasma concentration of AT- Ⅱ and HR did not change significantly through out the study. Plasma CGRP concentration and MAP decreased significantly during operation at T2-4 as compared to the baseline values （T1）. Plasma ET concentration increased significantly at clipping （ T3 ） as compared to that at T2. Conclusion The action of vaso-constrictors （AT- Ⅱ , ET） predominates over that of vaso-dilator during operation. It is important to prevent acute cerebral vasospasm during intracranial aneurysm clipping.

关 键 词：二异丙酚 芬太尼 血管紧张素Ⅱ 内皮缩血管肽类 降钙素基因相关肽 脑动脉瘤 

分 类 号：R614[医药卫生—麻醉学]