地氟醚-瑞芬太尼麻醉对烟雾病患者脑血管重建术中脑氧供需平衡的影响  

Effect of desflurane-remifentanil anesthesia on balance between cerebral oxygen supply and demand during cerebral revascularization in patients with moyamoya disease

作　　者：王中玉[1] 冯凤喜 马燕妮 王晓慧[1] 李红伟[2] 李治松[1] Wang Zhongyu;Feng Fengxi;Ma Yanni;Wang Xiaohui;Li Hongwei;Li Zhisong(Department of Anesthesiology and Perioperative Medicine,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neurosurgery,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,450052 [2]郑州大学第一附属医院神经外科,450052

出　　处：《中华麻醉学杂志》2019年第7期855-858,共4页Chinese Journal of Anesthesiology

基　　金：河南省科技厅科技攻关重点推广项目(20190284)。

摘　　要：目的评价地氟醚-瑞芬太尼麻醉对烟雾病患者行脑血管重建术中脑氧供需平衡的影响.方法择期行颞浅动脉-大脑中动脉搭桥术的烟雾病患者40例,ASA分级Ⅰ或Ⅱ级,年龄18~64岁,性别不限,BMI 18~25 kg/m^2.采用随机数字表法分为2组(n=20):地氟醚-瑞芬太尼组(D组)和丙泊酚-瑞芬太尼组(P组).麻醉诱导:静脉注射依托咪酯0.3 mg/kg、舒芬太尼0.4~0.5μg/kg和顺阿曲库铵0.15~0.20 mg/kg,气管插管术后行机械通气,维持呼吸末二氧化碳分压35~45 mmHg.麻醉维持:P组静脉输注丙泊酚4~6 mg·kg^-1·h^-1,D组吸入4%~6%地氟醚,2组静脉输注瑞芬太尼0.1~0.3μg·kg^-1·min^-1,间断追加顺阿曲库铵维持肌松,维持BIS值40~60.分别于气管插管后15 min时(T1)、切皮后30 min时(T2)、硬膜打开即刻(T3)、血管搭桥灌通即刻(T4)和术毕即刻(T5)时,采集桡动脉血样和颈内静脉球部血样行血气分析,记录颈内静脉球血氧饱和度(SjvO2),计算动脉-颈内静脉球部血氧含量差(Da-jvO2)和脑氧摄取率(CO2 ER).结果与P组比较,D组T3-6时Da-jvO2和T4-6时CO2ER降低,T4-6时SjvO2升高(P<0.05);与T1时比较,D组T5时Da-jvO2降低,SjvO2升高(P<0.05);与T3时比较,P组T5时CO2ER降低,SjvO2升高(P<0.05);与T4时比较,P组T5时CO2ER降低,SjvO2升高,D组T5时CO2ER降低,SjvO2升高(P<0.05).结论与丙泊酚-瑞芬太尼麻醉相比,地氟醚-瑞芬太尼麻醉可更好地维持烟雾病患者脑血管重建术中脑氧供需平衡状态.Objective To evaluate the effect of desflurane-remifentanil anesthesia on balance between cerebral oxygen supply and demand during cerebral revascularization in the patients with moyamoya disease.Methods Forty patients of both sexes with moyamoya disease,aged 18-64 yr,with body mass index of 18-25 kg/m^2,undergoing superficial temporal artery-middle cerebral artery anastomosis,were allocated into 2 groups using a random number table method:desflurane-remifentanil group(D group)and propofol-remifentanil group(P group),with 20 cases in each group.Anesthesia was induced by intravenously injecting etomidate 0.3 mg/kg,sufentanil 0.4-0.5μg/kg,and cis-atracurium 0.15-0.2 mg/kg.The patients were mechanically ventilated after tracheal intubation,and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.Anesthesia was maintained with propofol 4-6 mg·kg^-1·h^-1(group P),4%-6% desflurane(group D),remifentanil 0.1-0.3μg·kg^-1·min^-1,remifentanil 0.1-0.3μg·kg^-1·min^-1 and intermittent intravenous boluses of cis-atracurium,and BIS value was maintained at 40-60.At 15 min after intubation(T1),30 min after skin incision(T2),immediately after opening the dura mater(T3),immediately after vascular bypass and patency(T4),and at the end of surgery(T5),blood samples were obtained from the radial artery and internal jugular bulb for blood gas analysis,jugular venous oxygen saturation(SjvO2)was recorded,and arteriovenous blood O2 content difference(Da-jvO2)and cerebral O2 extraction rate(CERO2)were calculated.Results Compared with group P,Da-jvO2at T3-6 and CERO2 at T4-6 were significantly decreased,and SjvO2 was increased at T4-6 in group D(P<0.05).Compared with the value at T1,Da-jvO2 was significantly decreased,and SjvO2 was increased at T5 in group D(P<0.05).CERO2 was significantly lower,and SjvO2 was higher at T5 than at T3 in group P(P<0.05).Compared with the values at T4,CERO2 was significantly decreased,and SjvO2was increased at T5 in P and D groups(P<0.05).Conclusion Compared with propofol-remifentanil a

关 键 词：麻醉药 吸入 哌啶类 脑底异常血管网病 脑血管重建术 脑氧供需平衡 

分 类 号：R61[医药卫生—外科学]