七氟烷、丙泊酚对近红外光谱脑氧饱和度影响的研究
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摘要
目的研究七氟烷、丙泊酚对近红外光谱脑氧饱和度的影响,寻求手术中较优的脑保护方法方法选取2018年1月—2019年1月本院择期行经腹结肠癌根治术的患者60例作为研究对象,随机分为七氟烷组(T组) 30例和丙泊酚组(C组) 30例;两组患者采用相同的诱导方案:咪达唑仑0.04 mg/kg、顺式阿曲库铵0.15 mg/kg、丙泊酚2 mg/kg、舒芬太尼0.5 ug/kg。T组患者维持采用吸入浓度为2%～3%的七氟烷,并且根据麻醉深度间断追加舒芬太尼和顺式阿曲库铵; C组患者采取全凭静脉麻醉维持方案:丙泊酚4～12 mg/kg/h泵注,并根据麻醉深度间断追加舒芬太尼和顺式阿曲库铵;记录两组患者麻醉诱导前(T1)、诱导后5 min(T2)、手术开始30 min(T3)、手术开始60 min(T4)和手术结束(T5)五个时间点近红外光谱脑氧饱和度和平均动脉压(MAP)的数值。结果两组患者各时间点MAP差异比较无统计学意义(P>0.05);两组患者组内比较:T2相比于T1时近红外光谱脑氧饱和度数值有较大幅度的上升(P<0.01); T组在T2、T3、T4、T5四个时间点脑氧饱和度数值要高于C组,差异具有统计学意义(P<0.01)。结论七氟烷在结肠癌根治术中可以增加脑血流量,提高脑氧饱和度数值,脑保护效果优于丙泊酚;七氟烷麻醉在结肠癌根治术中可以作为较优的麻醉方法,值得临床推广。
Objective The effects of sevoflurane and propofol on near-infrared spectroscopy regional cerebral oxygen saturation techniques were studied and to seek for better brain protection in surgery.Methods 60 cases of patients undergoing trans-abdominal colon cancer radical resection in our hospital were selected. They were randomly divided into sevoflurane group( group T) and propofol group( group C).The two groups were given the same induction regimen: midazolam 0.04 mg/kg,cis-atracurium 0.15 mg/kg,propofol 2 mg/kg,sufentanil 0.5 ug/kg.Sevoflurane at a concentration of 2%-3% was maintained in the T group,sufentanil and cis-acurium were added intermittently according to the anesthesia depth. The patients in group C were given intravenous anesthesia for maintenance: Propofol 4 ～ 12 mg/Kg/h was pumped,and sufentanil and cis-acurium were added intermittently according to the anesthesia depth.The values of cerebral oxygen saturation and mean arterial pressure( MAP) at five time points: before anesthesia induction( T1),5 minutes after anesthesia induction( T2),30 minutes after surgery( T3),60 minutes after surgery( T4) and 5 minutes after surgery( T5) were recorded.Results There was no significant difference in MAP at each time point between the two groups( P > 0. 05). Intra-group comparison of patients in the two groups: compared with T1,T2 showed a significant increase in cerebral oxygen saturation by near-infrared spectroscopy( P<0.01).The cerebral oxygen saturation in group T at the time points of T2,T3,T4 and T5 were higher than those of group C,and the differences were statistically significant( P<0.01).Conclusions Sevoflurane could increase cerebral blood flow and increase cerebral oxygen saturation during radical resection of colon cancer. Sevoflurane anesthesia could be used as an optimal anesthesia method in the radical resection of colon cancer,it is worthy of clinical promotion.
Objective The effects of sevoflurane and propofol on near-infrared spectroscopy regional cerebral oxygen saturation techniques were studied and to seek for better brain protection in surgery.Methods 60 cases of patients undergoing trans-abdominal colon cancer radical resection in our hospital were selected. They were randomly divided into sevoflurane group( group T) and propofol group( group C).The two groups were given the same induction regimen: midazolam 0.04 mg/kg,cis-atracurium 0.15 mg/kg,propofol 2 mg/kg,sufentanil 0.5 ug/kg.Sevoflurane at a concentration of 2%-3% was maintained in the T group,sufentanil and cis-acurium were added intermittently according to the anesthesia depth. The patients in group C were given intravenous anesthesia for maintenance: Propofol 4 ～ 12 mg/Kg/h was pumped,and sufentanil and cis-acurium were added intermittently according to the anesthesia depth.The values of cerebral oxygen saturation and mean arterial pressure( MAP) at five time points: before anesthesia induction( T1),5 minutes after anesthesia induction( T2),30 minutes after surgery( T3),60 minutes after surgery( T4) and 5 minutes after surgery( T5) were recorded.Results There was no significant difference in MAP at each time point between the two groups( P > 0. 05). Intra-group comparison of patients in the two groups: compared with T1,T2 showed a significant increase in cerebral oxygen saturation by near-infrared spectroscopy( P<0.01).The cerebral oxygen saturation in group T at the time points of T2,T3,T4 and T5 were higher than those of group C,and the differences were statistically significant( P<0.01).Conclusions Sevoflurane could increase cerebral blood flow and increase cerebral oxygen saturation during radical resection of colon cancer. Sevoflurane anesthesia could be used as an optimal anesthesia method in the radical resection of colon cancer,it is worthy of clinical promotion.
引文
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[4]靳乐,黄海燕.七氟醚吸入麻醉对急性颅内出血开颅手术患者的脑保护作用[J].现代中西医结合杂志,2018,27(32):3628-3630,3639.
[5] Valencia L,Rodríguez-Pérez A,Kühlmorgen B. Does sevoflurane preserve regional cerebral oxygen saturation measured by nearinfrared spectroscopy better than propofol?[J]. Ann Fr Anesth Reanim,2014,33:e59-65.
[6] Ruman T,imurina T,Gulam D,et al. Sevoflurane preserves regional cerebral oxygen saturation better than propofol:Randomized controlled trial[J].J Clin Anesth 2017; 36:110-117.
[7] Rhondali O,Juhel S,Mathews S,et al. Impact of sevoflurane anesthesia on brain oxygenation in children younger than 2 years[J].Paediatr Anaesth,2014,24:734-740.
[2]胡辉华,常会民.重型颅脑损伤开颅术中脑保护措施的临床运用[J].重庆医学,2013,42(11):1286-1288.
[3] Silva A,Venncio C,Ortiz AL,et al. The effect of high doses of remifentanil in brain near-infrared spectroscopy and in electroencephalographic parameters in pigs[J]. Vet Anaesth Analg,2014,41:153-162.
[4]靳乐,黄海燕.七氟醚吸入麻醉对急性颅内出血开颅手术患者的脑保护作用[J].现代中西医结合杂志,2018,27(32):3628-3630,3639.
[5] Valencia L,Rodríguez-Pérez A,Kühlmorgen B. Does sevoflurane preserve regional cerebral oxygen saturation measured by nearinfrared spectroscopy better than propofol?[J]. Ann Fr Anesth Reanim,2014,33:e59-65.
[6] Ruman T,imurina T,Gulam D,et al. Sevoflurane preserves regional cerebral oxygen saturation better than propofol:Randomized controlled trial[J].J Clin Anesth 2017; 36:110-117.
[7] Rhondali O,Juhel S,Mathews S,et al. Impact of sevoflurane anesthesia on brain oxygenation in children younger than 2 years[J].Paediatr Anaesth,2014,24:734-740.