不同麻醉深度对150例脑外科手术患者脑氧代谢指标的影响  

Effects of different anesthesia depths on the cerebral oxygen metabolism indexes in 150 patients undergoing brain surgery

作　　者：刘园园[1] 王培[1] 褚海辰[1] LIU Yuanyuan;WANG Pei;CHU Haichen(Department of Anesthesiology,The Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong,China)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266000

出　　处：《山东大学学报（医学版）》2020年第12期65-71,共7页Journal of Shandong University:Health Sciences

摘　　要：目的适宜的麻醉深度是确保患者获得最佳麻醉效果的重要前提,分析不同麻醉深度对脑外科手术患者脑氧代谢指标的影响。方法选取2018年9月至2019年9月在本院接受脑外科手术的患者150例,根据电脑数字表法随机分为3组,A组50例麻醉深度指数(NTI)为47~56,麻醉深度级别(NTS)为D1;B组50例NTI为37~46,NTS为D2;C组50例NTI为27~36,NTS为E0,术中均予以静脉麻醉诱导及维持,以丙泊酚调节和维持不同麻醉深度,记录各组患者的麻醉药品使用量,并于麻醉诱导前(T0)、气管插管前(T1)、气管插管后即刻(T2)、手术开始(T3)、手术结束(T4)、拔管时(T5)测定各组血液流变学及脑氧代谢指标,测定指标数据采用两因素方差分析。结果(1)麻醉药物及剂量:丙泊酚、瑞芬太尼和苯磺顺阿曲库铵中,A、B、C各组丙泊酚用量(F=682.810,P<0.001)均值差异有统计学意义,随麻醉深度增加,用量上升(1294.88±37.45、1354.80±44.56和1589.02±43.81)。(2)3组患者血液流变学指标的对比:平均动脉压、心率随麻醉深度增加,测值呈下降趋势;平均动脉压、心率随麻醉时间而波动,平均动脉压测值A组呈上升趋势,B、C组呈下降趋势,心率测值A组呈上升趋势,B、C组呈上升后下降趋势,均值差异有统计学意义(P<0.05)。(3)3组患者脑氧代谢指标随麻醉深度增加,颈静脉球血氧饱和度(SjvO2)、动脉血氧含量(CaO2)测值呈上升趋势,桡动脉-颈内静脉球部血氧含量差(Da-jvO2)、脑氧摄取率(CERO2)、动脉血氧分压(PaO2)测值呈下降趋势;随麻醉时间变化,SjvO2、CaO2、PaO2测值呈上升趋势,Da-jvO2、CERO2测值呈下降趋势,均值差异有统计学意义(P<0.05)。结论D1、D2和E0麻醉深度均能使脑外科患者术中血流动力学维持稳定状态,促使脑氧供平衡相对稳定且脑代谢处于代偿范围内,同时深麻醉方案可减轻脑外科手术麻醉对脑组织的损伤程度和术中脑氧代谢失衡。Objective To analyze the effects of different anesthesia depths on the cerebral oxygen metabolism indexes in patients undergoing brain surgery.Methods A total of 150 patients undergoing brain surgery in our hospital during Sep.2018 and Sep.2019 were randomized into 3 groups,with 50 patients in each group.The narcotrend index(NTI)was 47-56,37-46,and 27-36,respectively,in groups A,B and C.The narcotrend stage(NTS)was D1,D2,and E0,respectively,in groups A,B and C.During the operation,intravenous anesthesia was induced and maintained,propofol was used to adjust and maintain different anesthesia depths,and the amounts of anesthetic drugs used in each group were recorded.The blood rheology and cerebral oxygen metabolism indicators of each group were measured before anesthesia induction(T0),before tracheal intubation(T1),immediately after tracheal intubation(T2),start of surgery(T3),end of surgery(T4)and extubation(T5).Data collected were analyzed with two-factor analysis of variance.Results(1)Anesthetic drugs and dosages:among propofol,remifentanil,and cisatracurium besilate,only the average dosage of propofol had a statistically significant difference among the 3 groups,and the dosage increased as the depth of anesthesia increased(1294.88±37.45,1354.8±44.56,1589.02±43.81,F=682.810,P<0.001).(2)Hemorheological indexes:the mean arterial pressure(MAP)and heart rate(HR)decreased with the depth of anesthesia.As the time of anesthesia prolonged,MAP showed an upward trend in group A,and a downward trend in groups B and C;HR showed an upward trend in group A,and an upward trend and then a downward trend in groups B and C(P<0.05).(3)Cerebral oxygen metabolism indexes:as the depth of anesthesia increased,the measured values of jugular bulb venous oxygen saturation(SjvO2)and arterial oxygen content(CaO2)showed an upward trend,while the measured values of difference of arteriovnous oxygen(Da-jvO2),cerebral oxygen extraction ratio(CERO2)and arterial blood oxygen partial pressure(PaO2)showed a downward trend;as the time of anesth

关 键 词：麻醉深度 脑外科 脑氧代谢 血液流变学 

分 类 号：R614[医药卫生—麻醉学]