摘要
目的 观察颅内动脉瘤夹闭术时行异氟醚控制性降压对病人血流动力学及血 β2 微球蛋白( β2 MG)和肌酐含量变化的影响。方法 3 2例颅内动脉瘤病人在全麻下于剥离夹闭动脉瘤时 ,加大异氟醚吸入浓度 ,使平均动脉压 (MAP)下降 3 0 %～ 4 0 % ,夹闭动脉瘤后 ,减少异氟醚浓度 ,MAP回升至降压前水平。采用Swan Ganz漂浮导管监测降压前、中、后血流动力学各项指标动态变化 ,同时测定相应阶段血 β2 MG及肌酐含量。结果 降压期间心输出量 (CO)、心脏指数 (CI)、每搏量 (SV)、心搏指数(SI)、中心静脉压 (CVP)、右心室作功指数 (RVSWI)及心率 (HR)变化较少 ,差异无显著意义 (t <2 0 4 0 ,P >0 0 5 )。左心室作功指数 (LVSWI)、体循环阻力 (SVR) ,肺循环血管阻力 (PVR)、冠状动脉灌注压 (CPP)及心率收缩压乘积 (血压×HR)在脑膜切开时及降压 3 0分钟时分别为 ( 5 7± 12 )和 ( 4 7±2 93 )g·m·beat-1·M-2 、( 12 3± 2 9)和 ( 10 0± 3 1)kPa·s-1·L-1、( 9± 3 )和 ( 6± 3 )kPa·s-1·L-1、( 7 9± 1 1)和 ( 5 9± 0 8)kPa、( 89± 15 )和 ( 86± 16)次 /min。差异均有显著意义 (t≥ 2 5 2 3 ,P <0 0 5 )。降压前后血清 β2 MG及含量无变化 ,而且异氟醚降压可控性好 ,停止降压后不出现反跳现象。结?
Objective To investigate the effects of isoflurane induced hypotension on the hemodynamics and the changes of plasma β 2 microglobulins and creatine during cerebral aneurysm operation Methods Thirty two cerebral anuerysm patients were operated under general anesthesia Anesthesia was induced with droperidol, fentayl, sodium pentothal and pavolon intravenously After tracheal intubation, the isoflurane was inhalated to maintain anesthesia The concentration of isoflurane was elevated to reduce MAP by 30%～40% during dissection and occlusion of tumor and the level maintained for 30～45 min Hemodynamic values were measured with Swan Ganz technique The hemodynamic parameters(CO, CI, SV, SI, SVR, LVSWI, RVSWI, CVP, CPP, RPP and HR) which were measured with Swan Ganz technique before, during and after isoflurane induced hypotension were compared Blood samples were drawn in given time intervals to determine the concentration of plasma β 2 Microglobulins(β 2 MG) by radioimmunoassay Changes in hemodynamics and the plasma β 2 MG and creatinine (Cr) after deliberate hypotension of isoflurane were recorded at the same time Results No significant changes of CO, CI, SV, SI, RVSWI, CVP, HR and ECG tracing were observed during hypotension ( P >0 05). SVR,PVR, LVSWI,Cpp and Rpp were significantly decreased during hypotension( P <0 05) but the risk of myocardial ischemia and deoxygenation was not increased No effect was found on the plasma β 2 MG and Cr during isoflurane induced hypotension in patients undergoing cerebral aneurysm cling operation Conclusion Hypotension induced by isoflurane during cerebral aneurysm operation is able to keep a good balance of myocardial oxygen delivery and consumption, and keep a good myocardial function
出处
《中华医学杂志》
CAS
CSCD
北大核心
1999年第9期683-685,共3页
National Medical Journal of China
关键词
血液动力学
Β2微球蛋白
脑动脉瘤
异氟醚
Ethers
Blood pressure
Hemodynamics
β 2 microglobulins
Cerebral aneurysm
