【摘要】 目的 研究在异丙酚全凭静脉麻醉下利多卡因对幕上肿瘤切除术患者脑葡萄糖和氧代谢的影响。方法 24例幕上肿瘤患者随机分为利多卡因组(A组)和对照组(B组),每组12例。A组全麻诱导及维持应用异丙酚、利多卡因、哌库溴铵、芬氟合剂;B组除不用利多卡因外,其余与A组相同。分别于全麻诱导前(T0)、气管插管即刻(T1)、手术分离(T2)与切除肿瘤(T3)及缝硬脑膜时(T4)同步采集颈内静脉球部和桡动脉血进行血气分析,乳酸、血糖含量测定。结果 (1)和A组相比,T1时B组颈内静脉球部血氧饱和度明显升高,桡动脉血氧含量(CaO2)与CjvO2之差、脑氧摄取率降低(P<0.05)。(2)两组T2-4的血氧含量(CjvO2)、CaO2、颈内静脉球部血乳酸与动脉乳酸及其两者之差(jvaDLac)和乳酸生成率均低于T0(P<0.05)。但两组之间比较差异无统计学意义。结论 异丙酚联合利多卡因可减轻幕上肿瘤切除术患者全麻诱导、气管插管对脑氧供需平衡的影响,但尚不能对术中脑氧供需平衡与乳酸代谢产生明显影响。更多还原

【Abstract】 ObjectIve To InvestIgate the balance between cerebral O2 supply and consumptIon and glucose metabolIsm durIng supratentorIal tumor resectIon under total Intravenous anesthesIa (TIVA) wIth propofol. Methods Twenty-four patIents of ASA grade Ⅰ- Ⅱ aged 20-55 undergoIng electIve supratentorIal tumor resectIon were randomly dIvIded Into 2 groups : lIdocaIne group (A, n = 12) and control group (B, n - 12) . After sedatIon wIth Intravenous scopolamIne 0.3 mg, mIdazolam 0.02 mg·kg-1 and droperIdol-fentanyl mIxture 0.03 ml· kg-1 radIal artery was cannulated for Bp monItorIng and blood samplIng and left Internal jugular veIn was cannulated retrogradely and the catheter was advanced cephalad untIl jugular bulb for blood samplIng. In lIdocaIne group anesthesIa was Induced wIth lIdocaIne 1.5 mg·kg1, propofol 2 mg·kg1, droperIdol-Ientanyl mIxture 0.04 ml·kg-1 and pIpecuronIum 0.15 mg · kg1 and maIntaIned wIth propofol InfusIon at 6-8 mg·kg-1·h-1 and IntermIttent I. v. boluses of fentanyl and pIpecuronIum. LIdocaIne was Infused after InductIon of anesthesIa at 11.7 mg ·kg1· h-1 for 20 mIn then InfusIon was maIntaIned at 2 mg ·kg1· h-1 .In control group lIdocaIne was replaced by normal salIne. The patIents were mechanIcally ventIlated (VT 6-8 ml·kg1 , RR 12-14 bpm) and PETCO2 was maIntaIned at 29-31 mm Hg In both groups. Blood volume and hemodynamIcs were well maIntaIned durIng operatIon. Blood samples were taken from artery (a) and jugular venous bulb (jv) sImultaneously before InductIon of anesthesIa (T0, baselIne), at IntubatIon (T1), whIle tumor was beIng Isolated (T2) and resected (T3) and at the closure of dura (T4 ) , for blood gas analysIs and determInatIon of Hb and glucose and lactate concentratIon. The dIfference In arterIal and jugular bulb O, content ( Ca-jvO2 ) , cerebral O2 extractIon rate (O3ER), glucose extractIon rate ( GER) and lactate productIon rate (LacPR) were calculated. Results The two groups were comparable wIth respect to demographIc data, duratIon of operatIon and the amount of propofol and fentanyl used. SjvO2 was sIgnIfIcantly lower, Ca-jvO2 greater and O2ER hIgher at T1 In group A than In group B. There was no sIgnIfIcant dIfference In GER and LacPR between the two groups. ConclusIon A bolus of lIdocaIne 1.5 mg·kg-1can increase cerebral O2 extraction during induction and intubation but lidocaine infusion at 2 mg·kg-1·h-1 has no significant effect on cerebral O2 supply/demand and glucose metabolism.更多还原