不同七氟醚麻醉深度对幼儿脑血管自动调节功能的影响  

Effects of different depths of anesthesia with sevoflurane on cerebrovascular autoregulation in infants

作　　者：孙震[1] 胡玉莹[1] 吕晶[1] 郑晓恬[2] 

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳市110004 [2]中国医科大学附属盛京医院神经功能科,沈阳市110004

出　　处：《中华麻醉学杂志》2014年第12期1449-1451,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价不同七氟醚麻醉深度对幼儿脑血管自动调节功能的影响.方法 择期尿道下裂成形术患儿20例,ASA分级Ⅰ级,年龄1-3岁.吸入6％七氟醚麻醉诱导后插入喉罩,进行机械通气.插入喉罩后行骶管阻滞.吸入七氟醚维持麻醉,调节呼气末七氟醚浓度,分别为1.8％、2.5％、3.3％和4.0％,每一个浓度均维持15 rmin,并在调节下一个浓度前即刻采集大脑中动脉的脑血流多普勒频谱,测定脑短暂充血反应率（THRR）.结果 七氟醚不同麻醉深度时THRR均大于1.09,在正常范围;与呼气末七氟醚浓度为1.8％时比较,2.5％、3.3％和4.0％时THRR降低（P＜0.05）,2.5％与3.3％时THRR比较无差异无统计学意义（P＞0.05）;与2.5％和3.3％时比较,4.0％时THRR降低（P＜0.05）.结论 虽然七氟醚麻醉对幼儿脑血管自动调节功能的抑制作用无明显临床意义,但是具有显著性意义.Objective To evaluate the effects of different depths of anesthesia with sevoflurane on cerebrovascular autoregulation in infants.Methods Twenty pediatric patients,of ASA physical status Ⅰ,aged 1-3 yr,undergoing elective hypospadias plasty surgery,were enrolled in the study.Single tube laryngeal mask was inserted after anesthesia was induced with 6％ sevoflurane inhalation.Caudal block was performed with 1 ml/kg of 0.2％ ropivacaine.Anesthesia was maintained with sevoflurane inhalation.The end-tidal sevoflurane concentration was adjusted to 1.8％,2.5％,3.3％ and 4.0％,and each concentration was maintained at this level for 15 min.The cerebral blood flow was collected from the middle cerebral artery immediately before adjusting the next concentration to record the Doppler spectrum and transient hyperemic response ratio （THRR） was measured.Results THRR at different depths of anesthesia with sevoflurane was larger than 1.09,and was within the normal range.THRR was significantly lower when the end-tidal concentration was 2.5％,3.3％ and 4.0％ than that obtained when end-tidal concentration was 1.8％.No significantdifference was detected in THRR between 2.5％ and 3.3 ％.THRR was significantly lower when the end-tidal concentration was 4.0 ％ than that obtained when the end-tidal concentration was 2.5％ and 3.3％.Conclusion Although the inhibitory effect on cerebrovascular autoregulation provided by sevoflurane anesthesia provides no obvious clinical significance,it shows statistical significance in infants.

关 键 词：麻醉药 吸入 儿童 脑血管循环 

分 类 号：R726.1[医药卫生—儿科]