异氟醚对眼部血液动力学的影响  

Effects of isoflurane on ocular hemodynamics

作　　者：年阿兴[1] 焦岿然[1] 张炳熙[1] 杨文利 王兰 

机构地区：[1]北京同仁医院麻醉科,100730

出　　处：《中华麻醉学杂志》2000年第1期14-16,共3页Chinese Journal of Anesthesiology

摘　　要：目的　研究异氟醚对眼部血液动力学的影响。方法　　选择无明显眼部疾病的成年非头颈手术患者 15例 ,静脉注射异丙酚、阿曲库铵快速诱导麻醉 ,插入喉罩 ,吸入异氟醚维持麻醉 .采用彩色多普勒成像仪 (CDI)观测麻醉前、异氟醚 1MAC和 1.5MAC 30min后的双眼动脉 (OA)、视网膜中央动脉 (CRA)和睫状后动脉 (PCA)的收缩期峰流速 (PSV)、舒张期末流速 (EDV )、平均流速(Tmax)和阻力指数 (RI)及血压、心率和SpO2的变化。结果　与麻醉前相比 ,OA的所有参数在各时刻无明显变化 (P >0 .0 5 ) ;CRA的PSV和EDV随异氟醚浓度增加而明显下降 (P <0 .0 5 ) ,但RI无明显差别 (P >0 .0 5 ) ;PCA的所测参数均显著降低 (P <0 .0 5 ) ,也随异氟醚浓度增加而逐渐下降 ,但RI无明显变化 (P >0 .0 5 )。麻醉后体循环舒张压与CRA和PCA的PSV和EDV呈明显的正相关 (P<0 0 1) ,与RI呈负相关 (P <0 0 5 ) ,但与OA各参数相关性不大。结论　异氟醚用于伴有潜在眼部缺血的患者 ,存在一定的风险 ;降低其吸入浓度 ,维持较高的体循环血压可在一定程度上改善眼部血供 ,减少缺血性眼部并发症的发生。Objective To observe the effects of isoflurane on ocular hemodynamics .Methods Fifteen patients without eye diseases undergoing non-head and non-neck surgical procedures ,were enrolled in this study. Anesthesia was induced with intravenous propofol and atracuronium, followed by laryngeal mask insertion, and was maintained with isoflurane. Peak systolic velocity(PSV),end diastolic velocity(EDV),Tmax and resistant index(RI) of double ophthalmic arteries, central retinal artery and posterior ciliary arteries were determined by coloured Doppler imaging before anesthesia, 30 min following inhalation of isoflurane 1.0MAC or 1.5MAC respectively . Blood pressure, heart rate and SpO 2 were also measured at above time points.Results As compared with those before anesthesia ,no significant changes were found in all above parameters of double ocular arteries in all time points; PSV and EDV of central retinal artery decreased significantly with increase of isoflurane level(P< 005), but without significant changes in RI(P>005); all above parameters of posterior ciliary artery decreased significantly ,with increase of isoflurane level(P< 005),but without significant changes in RI(P>005). The diastolic pressure was positively correlated with PSV and EDV of central retinal artery and posterior ciliary arteries ,and negatively with RI , but no correlation to all above parameters of double ophthalmic arteries.Conclusions It may be dangerous for the patients with potential ischemia of eyes undergoing isoflurane anesthesia. Decreasing its concentration and improving blood pressure can increase ocular blood supply to prevent ophthalmic ischemic complications from occurrence.

关 键 词：异氰醚 眼动脉 血液动力学 麻醉药 

分 类 号：R971.2[医药卫生—药品] R614[医药卫生—药学]