论文部分内容阅读
目的采用颈内静脉逆行置管监测颈内静脉血氧饱和度等指标,比较异丙酚和硫贲妥钠在全麻诱导中对脑氧供需平衡的影响。方法颅脑肿瘤手术病人25例,随机分为Ⅰ组12例,Ⅱ组13例,麻醉诱导Ⅰ组静注咪唑安定0.06 mg/kg、芬太尼2 μg/kg、异丙酚2 mg/kg、维库溴胺0.15 mg/kg;Ⅱ组改异丙酚为2.5 %硫贲妥钠5 mg/kg。诱导前5 min(T1)、后5 min(T2)、30 min(T3)同步测桡动脉和颈内静脉血气分析,计算SjO2、CEO2(CEO2=SaO2-SjO2)、Da-jO2等。结果诱导前两组的SjO2、Da-jO2均无显著差异,诱导后5 及30 minⅡ组的SjO2、Da-jO2高于Ⅰ组(P<0.01),而Ⅱ组的CEO2低于Ⅰ组(P<0.05)。结论在麻醉诱导过程中,异丙酚对脑氧供需平衡的影响要优于硫贲妥钠,但其作用机理可能主要是通过影响血压减少脑组织灌注,从而影响CMRO2/CBF。
Objective To evaluate the effects of propofol and thiopental on the balance of cerebral oxygen supply and demand during anesthesia induction by monitoring the internal carotid venous oxygen saturation with retrograde jugular vein catheterization. Methods Twenty - five patients with craniocerebral tumor were randomly divided into group Ⅰ (n = 12) and group Ⅱ (n = 13). Group Ⅰ received midazolam 0.06 mg / kg, fentanyl 2 μg / kg and propofol 2 mg / kg , Vecuronium bromide 0.15 mg / kg; Group Ⅱ Propofol 2.5% thiopental sodium 5 mg / kg. Blood gas analysis of radial artery and internal jugular vein were performed simultaneously 5 min (T1), 5 min (T2) and 30 min (T3) before induction. SjO2, CEO2 (CEO2 = SaO2-SjO2) and Da-jO2 were calculated. Results There was no significant difference in SjO2 and Da-jO2 between the two groups before induction. The levels of SjO2 and Da-jO2 in groupⅡ and groupⅡ were significantly higher than those in groupⅠ (P <0.01) <0.05). Conclusions Propofol has a better effect on the balance between supply and demand of cerebral oxygen during anesthesia induction than thiopental, but its mechanism may be mainly through affecting blood pressure and decreasing cerebral perfusion, which may affect CMRO2 / CBF.