异丙酚与七氟醚对颅脑肿瘤切除术患者术中脑血管自身调节功能影响的比较分析

摘要

Objective To compare the effect on cerebrovascular self regulating function betweenn Propofol and Sevoflurane undergoing cerebral tumor resection. Methods 103 cases of selective resection of craniocerebral tumor in our hospital from April 2015 to April 2017 were selected as the subjects, they were randomly divided into Propofol group (n=52) and Sevoflurane group (n=51). Combined anesthesia was induced with Propofol and Remifentanil for Propofol group, and combined anesthesia was induced with Sevoflurane and Remifentanil for Sevoflurane group. The mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2), pulsatility index (PI) and transient hyperaemic response ratio (THRR) at the time point before anesthesia induction (T1), during intubation (T2), 5 minutes after intubation (T3), 30 minutes after tumor resection (T4) and the end of the surgery (T5) between the two groups were compared. Result At the time of T2, T3, T4and T5, the MAP and HR of the two groups were significantly lower than those of T1time (P< 0.01), and the MAP and HR of Propofol group were significantly lower than those of Sevoflurane group (P < 0.01). At T2, T3, T4, and T5, the PI of Sevoflurane group was significantly higher than that at T1time (P<0.01), and THRR was significantly lower than that at T1time (P<0.01). At the time of T2, T3, T4and T5, the PI of Propofol group was significantly lower than that of Sevoflurane group (P<0.01), and the THRR was significantly higher than that of Sevoflurane group (P < 0.01). Conclusion There is no significant effect on cerebrovascular self regulating during Propofol anesthesia with Remifentanil undergoing cerebral tumor resection. Sevoflurane may reduce the compliance of cerebral small artery and the cerebrovascular self regulating function.%目的 对比异丙酚与七氟醚对颅脑肿瘤切除术患者术中脑血管自身调节功能的影响.方法选取2015年4月至2017年4月本院收治的103例择期行颅脑肿瘤切除术患者为研究对象,按照随机数表法将入选患者分为异丙酚组(52例)和七氟醚组(51例).异丙酚组患者采用瑞芬太尼+异丙酚复合麻醉,七氟醚组患者采用瑞芬太尼+七氟醚复合麻醉.比较两组患者麻醉诱导前(T1)、插管时(T2)、插管后5分钟(T3)、取瘤30分钟后(T4)及手术结束时(T5)5个时间点的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(oxygen saturation,SpO2)、搏动指数(pulse index,PI)及脑短暂充血反应率(transient hyperemic response ratio,THRR).结果 在T2、T3、T4、T5时刻,两组患者MAP和HR均显著低于T1时刻(P<0.01),且异丙酚组患者MAP和HR均显著低于七氟醚组(P<0.01).在T2、T3、T4、T5时刻,七氟醚组患者PI均显著高于T1时刻(P<0.01),THRR均显著低于T1时刻(P<0.01).在T2、T3、T4、T5时刻,异丙酚组患者PI均显著低于七氟醚组(P<0.01),THRR均显著高于七氟醚组(P<0.01).结论 异丙酚+瑞芬太尼复合麻醉对颅脑肿瘤切除术患者术中脑血管自身调节功能无明显影响,七氟醚可降低脑微小动脉顺应性,减弱患者脑血管自身调节功能.