地氟醚和丙泊酚对颅内动脉瘤夹闭术患者收缩和舒张脑血管物质的影响  

Effects of desflurane or propofol on cerebral vascular contracting and relaxing substances in patients undergoing aneurysm clipping

作　　者：罗芳[1] 张淑珍[1] 高勇[2] 王恩真[1] 王保国[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100050 [2]首都医科大学附属北京天坛医院检验科,100050

出　　处：《临床麻醉学杂志》2006年第3期161-163,共3页Journal of Clinical Anesthesiology

基　　金：北京市自然科学基金课题(7992021)

摘　　要：目的比较地氟醚和丙泊酚麻醉下颅内动脉瘤患者行夹闭术术中血管紧张素Ⅱ(AT-Ⅱ)、内皮素(ET)和降钙素基因相关肽(CGRP)的变化。方法择期开颅动脉瘤夹闭术患者88例,随机分为地氟醚组(n=45)和丙泊酚组(n=43),以吸入地氟醚或静注丙泊酚维持麻醉。分别于麻醉诱导前、剪硬膜、夹闭动脉瘤和动脉瘤夹闭后30 min采集动脉血,应用放免法检测血浆AT-Ⅱ、ET和CGRP的浓度。结果两组AT-Ⅱ四个时点间及组间比较差异均无显著意义;丙泊酚组夹闭动脉瘤时ET较剪硬膜时明显升高(P<0.05);组间比较,夹闭动脉瘤时丙泊酚组ET明显高于地氟醚组(P<0.05);两组剪硬膜、夹闭动脉瘤和动脉瘤夹闭后30 min CGRP较麻醉诱导前均有所降低。结论丙泊酚麻醉下夹闭动脉瘤时缩血管物质ET明显升高,而地氟醚麻醉下无此现象,提示丙泊酚麻醉中应注重扩血管治疗,以防急性脑血管痉挛的发生,地氟醚可能更适合应用于开颅动脉瘤夹闭术。Objective To compare the changes and calcitonin gene-relted peptide （CGRP） in patients of angiotensin- Ⅱ （AT- Ⅱ ）, endothelin （ET）, undergoing aneurysm clipping under desflurane or propofol anesthesia. Methods Eighty-eight patients scheduled for selective cranial aneurysm clipping were divided into d esflurane group （n=45） and propofol group （n= 43）. Anesthesia was maintained with desflurane or propofol respectively. Plasma concentrations of AT- Ⅱ , ET,and CGRP were measured with radioimmunoassay before induction, during dura opening, during aneurysm clipping, and at 30 min after aneurismal clipping,respectively. Results AT-Ⅱ was in normal range throughout the study in two groups, ET increased significantly during aneurysm clipping compared with that during dura opening in propofol group （P〈0.05）. Moreover, ET increased more significantly in propofol group than that in desflurane group during aneurysm clipping （P〈0.05）. CGRP slightly decreased compared with the baseline in both groups. Conclusion ET increases significantly during cranial aneurysm clipping under propofol anesthesia suggesting that vasodilatory treatment should be considered during the operation in order to prevent acute cerebral vasospasm. Desflurane may be a more suitable anesthetic for cranial aneurysm clipping.

关 键 词：血管紧张素-Ⅱ 内皮素 降钙素基因相关肽 脑动脉瘤 

分 类 号：R614[医药卫生—麻醉学]