七氟醚麻醉对脑葡萄糖能量代谢的影响  

The effects of sevoflurane anesthesia on human cerebral glucose metabolism

作　　者：孙绪德[1] 陈蕾[2] 徐礼鲜[3] 张惠[3] 柴伟[1] 张贵和[1] 高昌俊[1] 韩丽春[1] 于代华[1] 杨永慧[1] 

机构地区：[1]第四军医大学唐都医院麻醉科,西安市710038 [2]海军总医院妇产科 [3]第四军医大学口腔医学院麻醉科

出　　处：《临床麻醉学杂志》2007年第1期32-35,共4页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金资助项目(30271257)

摘　　要：目的研究吸人不同浓度七氟醚对健康志愿者脑内葡萄糖能量代谢（CMGlu）的影响，探讨七氟醚在人脑可能的作用部位。方法选择健康志愿者10名，每人分别做三次正电子发射计算机体层扫描：第一次在清醒状态下扫描作为对照；第二、三次分别吸人0．5MAC和1．0MAC七氟醚。结果（1）与清醒状态比较，镇静状态下脑电双频指数（BIS）明显降低（P〈0．05），MAP、RR和HR等指标无显著改变；而意识消失状态下，MAP、BIS显著降低，呼吸抑制，PgrCO2升高（P〈0．05）。（2）清醒时全脑内CMGlu计数为2268．3±91．2，吸入0．5MAC七氟醚麻醉后CMGlu计数降低至1875．9±86．2（P〈0．05），降低17％；吸入1．0MAC七氟醚后CMGlu计数降低至1556．3±80．4（P〈0．01）。与清醒时比较，吸入0．5MAC麻醉后脑内各区CMGlu计数均显著降低（P〈0．05），以丘脑、楔叶、楔前叶和扣带回cMGlu计数降低更为显著（P〈0．01），分别降低46％、41％、42％和40％；吸人1．0MAC麻醉后，全脑及脑内各区CMGlu计数均进一步降低8％～11％（P〈0．05）。结论七氟醚麻醉可明显降低全脑及脑内各区葡萄糖代谢，且程度与吸入七氟醚的浓度相关。丘脑、楔叶、楔前叶和扣带回对吸入七氟醚麻醉更为敏感，可能是七氟醚麻醉在脑内作用的主要靶区。Objective To investigate the effects of sevoflursne inhalation on cerebral glucose metabolism （CMGlu） in healthy volunteers. Position emission tomogrephy（PET）and investigate the specific effected by sevoflurane. Methods Each of ten volunteers underwent three times of PET seaning： After awake-baseline scaning（T1 ）, other two scaning were carried out during 0.5 MAC（T2） and 1.0 MAC（T3 ） sevoflurane anesthesia. Results （1） Compared with T1 , BIS was significant decreased at T2. BIS and MAP, RR and PET CO2 were all depressed at T3 compared with those at T1. （2） Awake whole brain glucose metablic count reduced from 2 268.3±91.2 at T1 to 1 875.9±86.2 at T2 （P〈0.05）and 1 556.3±80.4 at T3 （P〈0.01）. Regional glucose metablic counts of the thalamus, euneus precuneus and eingulated gyrus which tively. Conclusion Whole brain and regional were decreased by 46%, 41%, 42% and 40% respecmetabolism decreased significantly during sevoflurane anesthesia and correlatively to sevoflurane concentration. The thalamus cuneus, preeuneus,and cingulated gyrus are the most sensitive regions to sevoflurane, and may be the primary targets in isoflurane anesthesia.

关 键 词：七氟醚 正电子发射断层扫描 脑代谢 葡萄糖 脑电双频指数 

分 类 号：R614[医药卫生—麻醉学]