摘要
目的 观察不同麻醉对腹腔镜胆囊切除术患者二氧化碳气腹时脑氧合的影响。方法 腹腔镜胆囊切除术患者60例，ASAⅠ级或Ⅱ级，随机分为3组（n=20）：异氟醚组（Ⅰ组）、硬膜外复合异氟醚组（Ⅱ组）和硬膜外复合异丙酚组（Ⅲ组）。分别于气腹前即刻、气腹10、30min取桡动脉血和颈内静脉球部静脉血行血气分析，记录动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）、血红蛋白（Hb）浓度、颈内静脉血氧分压（PjvO2）和颈内静脉血氧饱和度（SjvO2）。根据Fick公式分别计算脑动脉和颈内静脉血氧含量及脑动静脉血氧含量差（Da-jvO2）。结果 与气腹前即刻比较，Ⅰ组、Ⅱ组气腹10、30min时SjvO2升高、Da-jvO2降低（P〈0．01）;与Ⅲ组比较，气腹10、30min时Ⅰ组、Ⅱ组SjvO2升高、Da-jvO2降低（P〈0.05）;与Ⅱ组比较，气腹10、30 min时Ⅰ组SjvO2升高、Da-jvO2降低（P〈0．05）。结论 硬膜外复合异丙酚静脉麻醉可改善术中脑组织的氧合，是腹腔镜手术患者较适宜的麻醉方法。
Objective To investigate the influence of different methods of anesthesia on cerebral oxygenation in patients during laparoscopic cholecystectomy under CO2 pneumoperitoneum. Methods Sixty ASA Ⅰor Ⅱ patients aged 55-60 yr weighing 55-76 kg undergoing laparoscopic cholecystectomy under CO2 pneumoperitoneum were randomly divided into 3 groups （ n = 20 each） ： group Ⅰ isoflurane; group Ⅱ epidural block ＋ isofhtrane and group Ⅲ epidural block ＋ propofol infusion. All patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg. Epidural catheter was placed at T9-10 interspace and advanced for 3 cm cephalad in group Ⅱ and Ⅲ Anesthesia was induced with fentanyl 4 μg/kg and propofol 2 mg/kg in all 3 groups. Tracheal intubation was facilitated with atracurium 0.6 mg/kg . The patients were mechanically ventilated （VT = 8 ml/kg , RR = 12 bpm, I ： E = 1 ： 2, FIO2 = 100% ）. PETCO2 was maintained 〈 40 mm Hg by adjusting tidal volume and respiratory rate. Anesthesia was maintained with inhalation of 1 MAC isoflurane in group Ⅰ or 0.6 MAC isnflurane in group Ⅱ or i.v. infusion of propofol at 4 mg·kg^-1·h^-1 in group Ⅲ . 2% lidocaine 6 ml was injected via epidural catheter every 45 min in group Ⅱ and Ⅲ. BIS was maintained at 55-60 during operation. Internal jugular vein was cannulated and the catheter was advanced cephalad until jugular bulb for blood sampling. Arterial and jugular bulb venous blood samples were taken simultaneously before （T0 ） and at 10 min （T1 ） and 30 min （T2） of CO2 pnenmoperitonenm for determination of PaO2 , PaCO2 and SaO2 and jugular bulb blood O2 partial pressure and saturation （PjvO2, SjvO2 ）. Cerebral arterial venous oxygen content differences （Da-jvO2） were calculated. Results SjvO2 was significantly increased and Da-jvO2 was significantly decreased during pneumoperitoneum at T1 and T2 as compared with the baseline values at T0 before CO2 pneumoperitoneum in group Ⅰ and Ⅱ SjvO2 was significantly higher and Da-jvO2 significantly lower at T1 and T2 in group Ⅰ and Ⅱ than in group m. Conclusion Propofol anesthesia combined with epidural block can attenuate CO2 pneumoperitoneum-induced increase in SjvO2 and decrease in Da-jvO2 thus improving cerebral oxygenation during operation, and is an anesthesia method of choice for surgery with CO2 pneumoperitoneum.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第5期420-423,共4页
Chinese Journal of Anesthesiology
关键词
麻醉
脑
氧耗量
二氧化碳
气腹
人工
胆囊切除术
腹腔镜
Anesthesia
Brain
Oxygen consumption
Carbon dioxide
Pneumoperitoneum, artificial
Cholecystectomy, laparoscopic
