摘要
目的探讨三种不同麻醉方法对重症颅脑损伤患者脑氧代谢的影响。方法选择2011年3月至2013年3月收治的45例重症颅脑损伤患者，按随机数字表法分为丙泊酚静脉麻醉组（A组）、七氟烷吸人麻醉组（B组）与静吸复合麻醉组（C组），每组15例。分别于麻醉前、插管即刻、插管后2vain、手术开始后10min及30min、术毕记录平均动脉压（MAP）、心率（HR），于麻醉诱导前、诱导完成即刻、手术开始后30rain及1h、术毕抽取桡动脉和颈内静脉球部血液行血气分析，计算各时间点的颈内静脉血氧饱和度（SjvO2）、桡动脉.颈内静脉血氧含量差（Da-jvO2）以及脑氧摄取率（CERO2）。结果三组患者手术开始后30min、手术开始后1h及术毕SjvO2均显著高于麻醉诱导前（A组：0.662.4±0.077、0.689±0.067、0.6854±0.066比0.6234±0.083；B组：0.6614±0.074、0.6814±0.072、0.6614±0.069比0.5984±0.092；C组：0.7154±0.072、0.7434±0.070、0.7134±0.075比0.6314±0.078），差异有统计学意义（P〈0.05），而手术开始后30min、手术开始后1h及术毕Da-jvO2、CERO2均显著低于麻醉诱导前[A组Da-jvO2：（41.24±6.3）、（41.6±8.1）、（41.24±6.3）ml／L比（49.24±9.2）ml／L，CER02：（33.04±1.9）％、（32.74±2.0）％、（32±34±1.9）％比（36.04±2.3）％；B组Da-jv02：（41.84±5.6）、（40.24±6.9）、（41.84±5.6）ml／L比（51.34±8.6）ml／L，CER02：（33.2±2.1）％、（33.0±2.6）％、（32.84±2.1）％比（34.74±3.1）％；C组Da-jvO2（39.54±6.8）、（38.74±7.0）、（40.24±6.8）ml／L比（48.84±9.7）ml／L，CER02：（31.84±2.9）％、（31.54±3.1）％、（32.94±2.3）％比（35.14±2.9）％]，差异有统计学意义（P〈0.05），且C组CERO：降低更为显著，差异有统计学意义（P〈0.05）。三组不同时间点MAP、HR比较差异均无统计学意义（P〉0.05）。结论丙泊酚静脉麻醉与七氟烷吸入麻醉均能有效地降低重症颅脑损伤患者围手术期脑氧代谢率，而且两者复合麻醉的效果更佳，血流动力学稳定。
Objective To investigate the effects of different anesthesia methods on cerebral oxygen metabolism in patients with severe traumatic brain injury. Methods Forty-five patients with severe traumatic brain injury from March 2011 to March 2013 were divided into propofol intravenous anesthesia group （group A）, sevoflurane inhalation anesthesia group （group B） and intravenous inhalational anesthesia group （group C） by random digits table method with 15 cases each. The mean artery pressure （MAP）,heart rate （HR） before anesthesia,immediately after tracheal intubation, 2 minutes after intubation, 10 min and 30 min after operation set and operation end were observed. The oxygen content of jugular venous （SjvO2）, jugular bulb venous oxygen content （Da-jvO2） and cerebral metabolic rate for oxygen （CERO2） before anesthesia induction, immediately finish anesthesia induction, 30 rain and 1 h after operation set andoperatin end were calculated. Results The SjvO2 values in three groups were at 30 min, 1 h after operation set and operation end was higher than that before anesthesia induction （group A：0.662±0.077,0.689 ± 0.067,0.685 ± 0.066 vs. 0.623 ± 0.083; group B：0.661 ± 0.074,0.681 ＋ 0.072,0.661 ± 0.069 vs. 0.598 ± 0.092; group C：0.715 ± 0.072,0.743 ± 0.070,0.713 ± 0.075 vs. 0.631 ± 0.078）,and there was significant difference （P〈0.05）. The Da-jvO2 values, CERO2 at 30 rain, 1 h after operation set and operation end was lower than that before anesthesia induction in three groups [ group A： Da-jvO2：（41.2 ± 6.3）, （41.6 ± 8.1）, （44.2 ± 6.3） ml/L vs.（49.2 ± 9.2） ml/L, CERO2：（33.0 ± 1.9）%, （32.7 ± 2.0）%, （32.3 ± 1.9）% vs.（36.0 ＋ 2.3）% ; group B： Da-jvO2：（41.8 ± 5.6）, （40.2 ± 6.9）, （41.8 ＋ 5.6） ml/L vs. （51.3 ＋ 8.6） ml/L,CERO2： （33.2 ±2.1）%, （33.0 ±2.6）%, （32.8 ±2.1）% vs. （34.7 ±3.1）%; group C： Da-jvO2：（39.5 ±6.8）, （38.7 ± 7.0）, （40.2 ＋ 6.8） ml/L vs. （48.8 ± 9.7） ml/L,CERO2：（31.8 ± 2.9）%, （31.5 ± 3.1）%, （32.9 ± 2.3）% vs.（35.1 ± 2.9）%] ,and there was significant difference （P〈0.05）. And group C was decreased more significantly （P〈 0.05）. There was no significant difference in MAP, HR among three groups （P〉0.05）. Conclusion Propofol intravenous anesthesia and sevoflurane inhalation anesthesia can effectively reduce perioperative cerebral metabolic rate of oxygen, and the balanced anesthesia has better cerebral protection with the stable hemodynamic.
出处
《中国医师进修杂志》
2013年第24期26-29,共4页
Chinese Journal of Postgraduates of Medicine
关键词
颅脑损伤
二异丙酚
七氟烷
脑氧代谢
Craniocerebral trauma
Propofol
Sevoflurane
Cerebral oxygen metabolism
