妇科腹腔镜手术患者分别开展七氟醚或异丙酚麻醉对脑血管自身调节能力和脑血流量的影响
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摘要
目的分析妇科腹腔镜手术患者分别开展七氟醚或异丙酚麻醉对脑血管自身调节能力和脑血流量的影响。方法河北省邯郸市中心医院于2016年3月-2018年11月收治了86例行腹腔镜手术治疗的妇科患者,通过数字表作为分组工具,将符合纳入要求的调研对象随机化分组,设定为异丙酚组和七氟醚组,每组各43例。其中,有43例患者予以七氟醚麻醉,有43例患者予以异丙酚麻醉。比较2组患者在建立气腹前10 min、气腹建立后10 min和气腹建立结束后10 min的脑血流量、脑短暂充血反应、脑氧饱和度值;比较2组中枢脑供去饱和状态的发生率。结果 2组在建立气腹前10 min、气腹建立结束后10 min的脑血流量差异无统计学意义(P>0.05);异丙酚组在气腹建立后10 min的脑血流量低于七氟醚组,差异有统计学意义(P<0.05)。异丙酚组患者气腹建立后10 min的脑短暂充血反应率高于七氟醚组,差异有统计学意义(P<0.05)。七氟醚组患者气腹建立后10 min的脑氧饱和度值高于异丙酚组,差异有统计学意义(P<0.05)。2组中枢脑供去饱和状态的发生率差异无统计学意义(P>0.05)。结论在实施妇科腹腔镜手术麻醉时,异丙酚作为麻醉诱导剂对大脑血管自我调节作用较小,对脑血流量的影响较大。
Objective To analyze the effects of sevoflurane or propofol anaesthesia on cerebral vascular self-regulation and cerebral blood flow in patients undergoing gynecologic laparoscopic surgery. Methods From March 2016 to November 2018, 86 gynecologic patients underwent laparoscopic surgery in Handan Central Hospital of Hebei Province were randomly divided into propofol group and sevoflurane group with 43 cases in each group. Among them, 43 patients received sevoflurane anesthesia and 43 patients received propofol anesthesia. Cerebral blood flow, transient cerebral hyperemia response and cerebral oxygen saturation were compared between the two groups 10 minutes before establishment of pneumoperitoneum, 10 minutes after establishment of pneumoperitoneum and 10 minutes after completion of establishment of pneumoperitoneum. Results There was no significant difference in cerebral blood flow between the two groups 10 min before the establishment of pneumoperitoneum and 10 min after the establishment of pneumoperitoneum(P>0.05). The cerebral blood flow was lower in the propofol group 10 min after pneumoperitoneum establishment. In the sevoflurane group, the difference was statistically significant(P<0.05). In the propofol group, the transient hyperemia response rate of the brain 10 min after the establishment of pneumoperitoneum was higher than that of the sevoflurane group(P<0.05). The cerebral oxygen saturation value of the sevoflurane group was higher than that of the propofol group 10 min after the establishment of pneumoperitoneum, and the difference was statistically significant(P<0.05). There was no significant difference in the incidence of desensitization in the central brain between the two groups(P>0.05). Conclusion In the implementation of gynecological laparoscopic anesthesia, propofol as an anesthesia inducer has little effect on cerebral vascular self-regulation, and has a greater impact on cerebral blood flow.
Objective To analyze the effects of sevoflurane or propofol anaesthesia on cerebral vascular self-regulation and cerebral blood flow in patients undergoing gynecologic laparoscopic surgery. Methods From March 2016 to November 2018, 86 gynecologic patients underwent laparoscopic surgery in Handan Central Hospital of Hebei Province were randomly divided into propofol group and sevoflurane group with 43 cases in each group. Among them, 43 patients received sevoflurane anesthesia and 43 patients received propofol anesthesia. Cerebral blood flow, transient cerebral hyperemia response and cerebral oxygen saturation were compared between the two groups 10 minutes before establishment of pneumoperitoneum, 10 minutes after establishment of pneumoperitoneum and 10 minutes after completion of establishment of pneumoperitoneum. Results There was no significant difference in cerebral blood flow between the two groups 10 min before the establishment of pneumoperitoneum and 10 min after the establishment of pneumoperitoneum(P>0.05). The cerebral blood flow was lower in the propofol group 10 min after pneumoperitoneum establishment. In the sevoflurane group, the difference was statistically significant(P<0.05). In the propofol group, the transient hyperemia response rate of the brain 10 min after the establishment of pneumoperitoneum was higher than that of the sevoflurane group(P<0.05). The cerebral oxygen saturation value of the sevoflurane group was higher than that of the propofol group 10 min after the establishment of pneumoperitoneum, and the difference was statistically significant(P<0.05). There was no significant difference in the incidence of desensitization in the central brain between the two groups(P>0.05). Conclusion In the implementation of gynecological laparoscopic anesthesia, propofol as an anesthesia inducer has little effect on cerebral vascular self-regulation, and has a greater impact on cerebral blood flow.
引文
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[7] YANG X L,WANG D,ZHANG G Y,et al.Comparison of the myocardial protective effect of sevoflurane versus propofol in patients undergoing heart valve replacement surgery with cardiopulmonary bypass[J].Bmc Anesthesiol,2017,17(1):37.
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[9] 鲍瑞军,张佩军,张庆.七氟醚或丙泊酚复合瑞芬太尼对妇科腹腔镜手术患者血流动力学的影响[J].山东医药,2012,52(44):61-63.
[10] CHAVAN S G,MANDHYAN S,GUJAR S H,et al.Comparison of sevoflurane and propofol for laryngeal mask airway insertion and pressor response in patients undergoing gynecological procedures[J].J Anaesthesiol Clin Pharmacol,2017,33(1):97-101.
[11] REN L Q,SUN X X,GUAN Y.Effects of sevoflurane or propofol combined with remifentanil anesthesia on clinical efficacy and stress response in pregnant women with pregnancy-induced hypertension[J].Eur Rev Med Pharmacol Sci,2018,22(6):1825-1829.
[12] TIAN H T,DUAN X H,YANG Y F,et al.Effects of propofol or sevoflurane anesthesia on the perioperative inflammatory response,pulmonary function and cognitive function in patients receiving lung cancer resection[J].Eur Rev Med Pharmacol Sci,2017,21(23):5515-5522.
[13] JI H L,KANG S H,KIM Y,et al.Effects of propofol-based total intravenous anesthesia on recurrence and overall survival in patients after modified radical mastectomy:a retrospective study[J].Korean J Anesthesiol,2016,69(2):126-132.
[14] KONDO Y,HIROSE N,MAEDA T,et al.Changes in cerebral blood flow and oxygenation during induction of general anesthesia with sevoflurane versus propofol[J].Adv Exp Med Biol,2016,876:479-484.
[15] ERDEM A F,SAHIN Y N,DOGAN N,et al.Effects of sevoflurane and propofol on S100β and neuron-specific enolase protein levels during cardiopulmonary bypass[J].Niger J Clin Pract,2016,19(2):278-283.
[2] LIU S,GU X,ZHU L,et al.Effects of propofol and sevoflurane on perioperative immune response in patients undergoing laparoscopic radical hysterectomy for cervical cancer[J].Medicine,2016,95(49):e5479.
[3] 孙建国.七氟醚复合麻醉和异丙酚用于妇科病腹腔镜手术的血流动力学及苏醒质量的影响对比[J].江西医药,2014,(11):1141-1144.
[4] NOWAK S,OLDAK A,KLUZIK A,et al.Impact of controlled induced hypotension on cognitive functions of patients undergoing functional endoscopic sinus surgery[J].Med Sci Monitor,2016,22:898-907.
[5] DE OLIVEIRA GS JR,BIALEK J,RODES M E,et al.The effect of sevoflurane compared to propofol maintenance on post-surgical quality of recovery in patients undergoing an ambulatory gynecological surgery:A prospective,randomized,double-blinded,controlled,clinical trial[J].J Clin Anesth,2017,43:70-74.
[6] 李晓亮.2种麻醉方法在妇科腹腔镜手术中胃肠道保护作用的比较[J].现代中西医结合杂志,2013,22(23):2592-2594.
[7] YANG X L,WANG D,ZHANG G Y,et al.Comparison of the myocardial protective effect of sevoflurane versus propofol in patients undergoing heart valve replacement surgery with cardiopulmonary bypass[J].Bmc Anesthesiol,2017,17(1):37.
[8] LIM J A,OH C S,YOON T G,et al.The effect of propofol and sevoflurane on cancer cell,natural killer cell,and cytotoxic T lymphocyte function in patients undergoing breast cancer surgery:an in vitro analysis[J].Bmc Cancer,2018,18(1):159.
[9] 鲍瑞军,张佩军,张庆.七氟醚或丙泊酚复合瑞芬太尼对妇科腹腔镜手术患者血流动力学的影响[J].山东医药,2012,52(44):61-63.
[10] CHAVAN S G,MANDHYAN S,GUJAR S H,et al.Comparison of sevoflurane and propofol for laryngeal mask airway insertion and pressor response in patients undergoing gynecological procedures[J].J Anaesthesiol Clin Pharmacol,2017,33(1):97-101.
[11] REN L Q,SUN X X,GUAN Y.Effects of sevoflurane or propofol combined with remifentanil anesthesia on clinical efficacy and stress response in pregnant women with pregnancy-induced hypertension[J].Eur Rev Med Pharmacol Sci,2018,22(6):1825-1829.
[12] TIAN H T,DUAN X H,YANG Y F,et al.Effects of propofol or sevoflurane anesthesia on the perioperative inflammatory response,pulmonary function and cognitive function in patients receiving lung cancer resection[J].Eur Rev Med Pharmacol Sci,2017,21(23):5515-5522.
[13] JI H L,KANG S H,KIM Y,et al.Effects of propofol-based total intravenous anesthesia on recurrence and overall survival in patients after modified radical mastectomy:a retrospective study[J].Korean J Anesthesiol,2016,69(2):126-132.
[14] KONDO Y,HIROSE N,MAEDA T,et al.Changes in cerebral blood flow and oxygenation during induction of general anesthesia with sevoflurane versus propofol[J].Adv Exp Med Biol,2016,876:479-484.
[15] ERDEM A F,SAHIN Y N,DOGAN N,et al.Effects of sevoflurane and propofol on S100β and neuron-specific enolase protein levels during cardiopulmonary bypass[J].Niger J Clin Pract,2016,19(2):278-283.