地氟醚对颅脑手术病人脑脊液压力及大脑中动脉血流速度的影响  

Effects of desflurane on cerebrospinal fluid pressure and blood flow velocity in the middle cerebral artery in patients undergoing craniotomy

作　　者：蔡劲松[1] 董振明[1] 翟俊霞[2] 

机构地区：[1]河北医科大学第二医院麻醉科,石家庄市050000 [2]河北省医科院

出　　处：《中华麻醉学杂志》2000年第1期17-20,共4页Chinese Journal of Anesthesiology

摘　　要：目的　观察地氟醚以不同MAC值维持麻醉期间对脑脊液压力 (CSFP)和大脑中动脉血流速率 (VmMCA)的影响。方法　 6 0名颅内肿瘤病人 ,随机分为 2组 ,A组选用地氟醚维持麻醉 ,B组选用异氟醚维持麻醉。每组病人又按维持麻醉的不同MAC值分为三小组 :分组MAC值为 0 .5、0 .8和 1.1。通过蛛网膜下腔导管监测CSFP的变化 ,分别于麻醉前、诱导插管时观察记录 ,并于MAC值稳定于预定值开始 ,每 5分钟测量一次直至手术开始。使用经颅超声多普勒监测仪 (TCD)监测VmMCA ,并于麻醉前、吸入麻醉药给予前和麻醉维持 45分钟时测量记录VmMCA。结果　地氟醚1 1MAC组的CSFP逐步升高并达到 16 .90± 4.0 1mmHg ,与基础值相比显著性增高 (P <0 .0 1) ,其他两小组及异氟醚各组的CSFP与基础值相比无显著性差异 (P >0 .0 5 )。地氟醚 1 1MAC组的VmM CA于麻醉维持 45分钟时与基础值相比显著性增快 (P <0 .0 5 ) ,而其他两小组及异氟醚各组的VmMCA与基础值相比无显著性差异 (P >0 .0 5 )。地氟醚组麻醉维持MAC值与 45分钟时的CSFP与VmMCA呈直线正相关 ,(r=0 .5 2 ,P <0 .0 5 )。结论　地氟醚可引起剂量依赖性CSFP和VmM CA升高 ,颅内压正常的病人 0 .8MAC地氟醚维持麻醉安全。Objective To evaluate the effect of desflurane on blood flow velocity in the middle cerebral artery (VmMCA) and cerebrospinal fluid pressure (CSFP).Methods Sixty patients were randomly assigned to two groups. In group A,the anesthesia was maintained with desflurane, and in group B, with isoflurane. In either group, patients were allocated to three subgroups according to different doses(05,08,1.1MAC). CSFP was measured through a lumbar subarachnoid catheter before surgical procedures,from induction to administration of the inhalational agent for 45min.VmMCA was measured by transcranial Doppler at baseline , postintubation and administration of agent for 45min. Results As compared with baseline,CSFP increased gradually and reached to 16.90±4.01mmHg in subgroup 1.1MAC of group A (P<0.01),but unchanged significantly in group B and other subgroups of group A (P>0.05). Compared with baseline, VmMCA increased significantly at 45th min following administration of agent in subgroup 11MAC of group A(P<0.05) ,but remained unchanged in group B and other subgroups of group A (P>005). In group A , a significant parallel correlation existed between the MAC levels and the values of VmMCA or CSFP (r=0.52,P<0.05) . Conclusions Desflurane can induce the increase in VmMCA and CSFP in dose-related way, 0.8 MAC of desflurane may be safely applied to anesthesia maitenance for the patient with normal cranial cerebrospinal fluid pressure.

关 键 词：脑脊液压力 脑血流速度 地氟醚 

分 类 号：R971.2[医药卫生—药品] R651.15[医药卫生—药学]