丙泊酚麻醉下脑氧供需平衡和大脑自动调节平台及其影响因素的研究  

Brain oxygen supply-demand balance and cerebral autoregulatory plateau under propofol anesthesia and influencing factors

作　　者：傅俊豪 陈妍 杨纯勇 鲁开智 FU Junhao;CHEN Yan;YANG Chunyong;LU Kaizhi(Department of Anesthesiology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院麻醉科,重庆400038

出　　处：《陆军军医大学学报》2022年第18期1845-1855,共11页Journal of Army Medical University

基　　金：国家自然科学基金青年科学基金(81601569)。

摘　　要：目的 探讨丙泊酚在静脉麻醉前后的脑氧供需平衡是否存在差异以及脑氧供需平衡和大脑自动调节平台的影响因素。方法 选取2020年6-10月于我院肝胆外科行开腹手术的53例患者,观测从入手术室至手术结束期间的局部脑氧饱和度(regional cerebral oxygensaturation, rSO)、脑组织血红蛋白浓度指数(cerebral tissue hemoglobin concentration index, THI)、平均动脉压(mean arterial pressure, MAP)。采用rSO以及THI评价脑的氧合情况。然后计算整个手术过程中rSO与MAP之间的移动线性Pearson相关系数,即COx,计算THI与MAP之间的移动线性Pearson相关系数,即THx。利用COx和THx探讨大脑自动调节的上下限和平台长度。间断采集血气分析,患者都采用标准化麻醉管理。结果 左右两侧脑rSO在麻醉前和麻醉后差异有统计学意义(左侧P<0.001,右侧P<0.001);左右两侧脑THI在麻醉前和麻醉后差异有统计学意义(左侧P<0.001,右侧P<0.001)。左右侧rSO和THI分别根据年龄、是否阻断肝门和手术时长分组比较差异都无统计学意义(P>0.05)。线性相关曲线显示左右脑THI随着年龄的增长有逐渐下降的趋势(左脑THI随年龄变化趋势r=-0.261 8,P=0.058 3;右脑THI随年龄变化趋势r=-0.283 6,P=0.039 6)。丙泊酚静脉麻醉下由COx界定脑血流自动调节下限、上限和调节范围分别为(81.98±12.63)、(93.67±13.69)、(11.22±8.38)mmHg。由THx界定脑血流自动调节下限、上限和调节范围分别为(79.96±10.61)、(93.77±12.34)、(13.79±8.63)mmHg。由COx和THx界定的CA上限、下限和调节范围根据年龄是否大于50岁、是否阻断肝门和手术时长是否大于360 min进行分组比较,差异无统计学意义(P>0.05)。结论 丙泊酚麻醉后会降低患者左右脑rSO和THI,左右脑THI受到年龄影响,脑血流自动调节的下限、上限以及自动调节范围不受年龄是否大于50岁、是否阻断肝门和手术时长是否大于360 min影响。Objective To investigate the differences in brain oxygen supply-demand balance before and after intravenous anesthesia with propofol, and determine the influencing factors of the balance and cerebral autoregulation plateau. Methods A total of 53 patients undergoing open hepatobiliary surgery in our hospital from June 2020 to October 2020 were enrolled in this study. Their local regional cerebral oxygen saturation(rSO), cerebral tissue hemoglobin concentration index(THI) and mean arterial pressure(MAP) were monitored and recorded from entering the operating room to the end of the operation. Brain oxygenation was assessed using rSOas well as using THI. Then the moving linear Pearson correlation coefficient between rSOand MAP was calculated and named as Cox, and the moving linear Pearson correlation coefficient between THI and MAP was also calculated and named as THx. The upper and lower limits and range of cerebral autoregulation(CA) were studied using COx and THx. Intermittent sampling of blood was performed for blood gas analysis. All patients underwent standardized anesthesia management. Results There were significant differences in rSOin the left and right brain before and after anesthesia(left: P<0.001, right: P<0.001), so were in THI in the left and right sides before and after anesthesia(left: P<0.001, right: P<0.001). There were no statistical differences in the left and right rSOand THI among those at different ages, with the porta hepatis being blocked or not, and with different operation durations(P>0.05). Linear correlation curve showed that the THI values of the left and right brain were decreased with age(left: r=-0.261 8, P=0.058 3;right: r=-0.283 6, P=0.039 6). Under propofol intravenous anesthesia, COx defined the lower limit, upper limit and range of CA were 81.98±12.63, 93.67±13.69 and 11.22±8.38 mmHg, respectively. THx defined the lower limit, upper limit and range of CA was 79.96±10.61, 93.77±12.34 and 13.79±8.63 mmHg, respectively. No obvious differences were seen in the upper limit, low

关 键 词：脑氧供需平衡 大脑血流自动调节范围 脑氧饱和度 脑组织血红蛋白浓度指数 

分 类 号：R331.37[医药卫生—人体生理学] R338.2[医药卫生—基础医学] R614.1