异丙酚对健康志愿者局部脑血流的影响  

Effect of propofol on regional cerebral blood flow in healthy volunteers

作　　者：张惠 孙绪德[2] 柴伟[2] 于代华[2] 汪静[3] 徐礼鲜 

机构地区：[1]第四军医大学口腔医院麻醉科,西安市710032 [2]第四军医大学唐都医院麻醉科,西安市710032 [3]第四军医大学西京医院核医学科,西安市710032

出　　处：《中华麻醉学杂志》2009年第2期115-117,共3页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金资助项目（30271257）

摘　　要：目的评价异丙酚对健康志愿者局部脑血流的影响，初步筛选其全麻作用的中枢靶位。方法健康志愿者7名，性别不限，年龄24—34岁，体重50～69kg，ASA Ⅰ级。志愿者随机静脉输注生理盐水4mg·kg^-1·h^-1（清醒状态）、异丙酚效应室靶浓度1．5μg／ml（镇静状态）和3．0μg／ml（意识消失状态），间隔至少48h。静脉输注生理盐水10min或达设定的效应室靶浓度后，稳定10min，静脉注射^99Tc^m-双半胱乙酯0．5mCi／kg，10min后停止输注异丙酚使志愿者清醒，并在清醒后10min内采用单光子发射断层扫描仪测定局部脑血流量（rCBF）。结果与清醒状态时比较，志愿者镇静状态时全脑CBF降低，大脑皮层rCBF降低（P〈0．05），皮层下区rCBF差异无统计学差异（P〉0．05），意识消失状态时全脑CBF、大脑皮层和皮层下区rCBF均降低（P〈0．05）；与镇静状态时比较，志愿者意识消失状态时小脑、顶叶、丘脑、扣带回、海马和额叶rCBF降低（P〈0．05）。3种状态下全脑CBF与BIS呈正相关（r=0．883，P〈0．05）。结论异丙酚产生镇静效应时，健康志愿者大脑皮层rCBF降低，产生意识消失效应时大脑皮层区和皮层下区rCBF均降低，尤其是丘脑、海马、扣带回等区域，提示这些区域可能是异丙酚麻醉的中枢作用靶位。Objective To investigate the effect of propofol on regional cerebral blood flow （rCBF） in healthy volunteers. Methods Seven healthy volunteers aged ：24-34 yr weighing 50-69 kg were enrolled in this study. The volunteers were kept in 3 sensorium states in a random order -- waking, sedated and Unconscious states by administering normal saline iv at 4 ml.kg^-1.h^-1 （ awake ）, propofol by TCI at a target-effect site concentration of 1.5 μg/ml （sedated） and 3.0 μg/ml （unconscious） respectively. The interval between the two sensorium states was at least 48 h.^99Tc^m-ECD 0.5 mCi/kg was given iv after normal saline had been infused for 10 min or target effect-site concentration had been set for 10 min. TCI of propofol was stopped at 10 min after ^99Tc^m-ECD injection and rCBF was determined by using single photon emission computer tomography within 10 min. Results Compaired with the waking state, rCBF decreased throughout the bmin, mainly in thalamus, cerebral cortex, hippocampus, cerebellum in sedated and unconscious state. Conclusion Propofol induces a decrease in global CBF. Low doses of propofol affect preferentially the CBF in cortical areas while high doses of propofol affect not only CBF in cortex but also subcortical bmin structures, particularly thalamus, hippocampus and cingulated gyrus, which may be the primary targets for anesthetic action.

关 键 词：二异丙酚 脑血流 单光子发射计算机断层成像 

分 类 号：R614[医药卫生—麻醉学]