不同麻醉深度对儿童围手术期脑氧代谢、血流动力学及应激反应的影响  

Effects of different anesthesia depth on cerebral oxygen metabolism,hemodynamics and stress response in children patients at perioperative period

作　　者：赵紫玉 姚溪[1] 滕云鹏[2] 徐钊 程方圆 ZHAO Ziyu;YAO Xi;TENG Yunpeng(Department of Anesthesiology,Shaanxi Provincial People’s Hospital,Shaanxi,Xi’an 710000,China)

机构地区：[1]陕西省人民医院麻醉科,西安市710000 [2]西安交通大学第二附属医院麻醉科

出　　处：《河北医药》2020年第17期2630-2632,2636,共4页Hebei Medical Journal

摘　　要：目的探讨不同麻醉深度对儿童患者围手术期脑氧代谢、血流动力学以及应激反应的影响。方法选择2018年3月至2019年3月收治的76例择期开腹手术患儿。采用随机数字表法分为对照组和观察组,每组38例。对照组在常规成人麻醉深度下进行手术,丙泊酚的起始维持剂量为10 mg·kg^-1·h^-1,采用6 mg·kg^-1·h^-1剂量维持至缝皮。观察组患儿为加深麻醉深度,丙泊酚的起始维持剂量调至15 mg·kg^-1·h^-1,20 min后减量,采用8 mg·kg^-1·h^-1剂量维持至缝皮。对比2组患儿血流动力学、脑氧代谢指标及应激反应指标。结果观察组患者T1、T2、T3、T4时段麻醉深度较对照组更深,差异有统计学意义(P<0.05)。观察组患儿术中T1、T2、T3、T4时段的脑动-静脉血氧含量差以及脑氧代谢率均低于对照组,差异均有统计学意义(P<0.05)。观察组患者T1、T2、T3、T4时段术中收缩压、平均动脉压较为稳定,明显优于对照组,差异有统计学意义(P<0.05)。结论通过应用起始维持剂量为15 mg·kg^-1·h^-1丙泊酚进行儿童手术,加深麻醉深度后可有效抑制手术应激反应,稳定血流动力学,降低脑氧代谢率,值得临床推广与关注。Objective To investigate the effects of different anesthesia depth on cerebral oxygen metabolism,hemodynamics and stress response in children patients at perioperative period.Methods A total of 76 children patients who were ready to receive elective laparotomy in our hospital from March 2018 to March 2019 were enrolled in the study,who were divided into control group and observation group according to random number table method,with 38 cases in each group.The patients in control group were operated under conventional adult anesthesia depth,and the initial maintenance dose of propofol was 10mg·kg^-1·h^-1,and 6mg·kg^-1·h^-1 was used to maintain the operation until the skin was sutured.For the patients in observation group,in order to deepen the anesthesia depth,the initial maintenance dose of propofol was adjusted to 15mg·kg^-1·h^-1 and decreased after 20min,and the dosage of propofol was maintained till skin suture.The hemodynamics indexes,cerebral oxygen metabolism indexes and stress response indexes were observed and compared between the two groups.Results The anesthesia depth at T1,T2,T3 and T4 in observation group was significantly deeper than that in control group(P<0.05).The cerebral arteriovenous oxygen content and cerebral oxygen metabolism rate at T1,T2,T3 and T4 in observation group were significantly lower than those in control group(P<0.05)Moreover the systolic blood pressure and mean arterial pressure in observation group at T1,T2,T3 and T4 were relatively stable,which were superior to those in control group(P<0.05).Conclusion The propofol with an initial maintenance dose of 15mg·kg^-1·h^-1 can effectively inhibit surgical stress response,stabilize hemodynamics and reduce cerebral oxygen metabolism rate after deepening anesthesia depth for pediatric surgery,therefore,which is worthy of clinical application and promotion.

关 键 词：麻醉深度 围手术期 应激反应 脑氧代谢 

分 类 号：R614[医药卫生—麻醉学]