七氟醚和异丙酚复合麻醉在腹腔镜下宫颈癌根治术中患者脑血流量和颅内压的比较研究

摘要

目的:了解在妇科腹腔镜手术中七氟醚和异丙酚复合麻醉下患者脑血流量和颅内压变化情况,比较二者之间的差异.方法:选择行妇科腹腔镜手术者30例,随机分成两组.Ⅰ组:使用8%的七氟醚复合瑞芬太尼麻醉,Ⅱ组:使用异丙酚复合瑞芬太尼麻醉.使用经颅多普勒超声仪测定麻醉前平卧位稳定后5min(T1),水平截石位稳定后5min(T2),行气管插管完成时刻(T3),行气管插管后5min(T4),气腹头低位时刻(T5),气腹低位后15min(T6)和气腹放气后10min(T7)患者的大脑动脉脑血流速率和搏动指数.结果:两组相较,Ⅱ组在T3时刻的大脑动脉脑血流速率和T3、T4时刻的搏动指数降低,Ⅰ组在T7时刻的大脑动脉脑血流速率和搏动指数都有明显降低,P＜0.05;组内比较:与T1时刻相比,Ⅰ组在T4、T7时刻的大脑动脉脑血流速率降低,Ⅱ组在T3、T4时刻的大脑动脉脑血流速率和搏动指数都有明显降低;两组T5、T6时刻的搏动指数都有明显升高,与T4比较,两组T5、T6时刻的大脑动脉脑血流速率明显升高,P＜0.05.结论:与异丙酚复合麻醉相比,七氟醚复合麻醉对气腹后降低患者的大脑动脉脑血流速率和搏动指数的作用更明显,但异丙酚复合麻醉对降低患者气腹之前的大脑动脉脑血流速率和搏动指数的作用明显.%Objective: To research and compare the changing situation of cerebral blood flow and intracranial pressure during laparoscopic gynecologic surgery performed under propofol and sevofiurane combined anesthesia . Method: Thirty ASA Ⅰ or Ⅱ patients were randomly divided into two groups ( n ＝ 15 each) :group Ⅰ and group Ⅱ. Anesthesia was induced with TCI of propofol in group Ⅱ or 8％ sevoflurane in group Ⅰ combined with TCI of remifentanil. Cerebral blood flow velocity and pulsatility index determined by TCD were recorded at 5 min after supine position ( T1 ) and 5 min after supine lithotomy position before induction ( T2 ), while tracheal tube was being inserted ( T3 ), 5 min after tracheal intubation ( T4 ), immediately and 15 rain after abdominal CO2 insufflation in trendelenburgiithotomy position ( T5 and T6 ), and at 10 min deflation of abdomen ( T7 ). Result: Cerebral blood flow velocity was significantly decreased at T3,4 in group Ⅱ and at T4.7 in group Ⅰ as compared with the baseline at T1, but it was increased at T5.6 in beth of the two groups;Pulsatility index was significantly decreased at T3.4 in group Ⅱ and at T4.7 in group Ⅰ ,but it was increased at T5,6 in both of two groups. Conclusion: When combined with remifentanil, sevoflurane could decrease significantly cerebral blood flow velocity and pulsatility index as propofol without significant effect on cerebral blood flow velocity and pulsatility index after deflation of abdomen. But propofol could decrease significantly cerebral blood flow velocity and pulsatility index before deflation of abdomen.