【摘要】 目的:探讨吸入麻醉药七氟烷复合丙泊酚用于动脉瘤介入栓塞手术控制性降压的应用效果。方法:选择择期行动脉瘤实施介入栓塞手术的患者55例,分为单纯使用七氟烷组(S组35例)和七氟烷复合丙泊酚组(SP组20例)。控制性降压过程中,平均动脉压(MAP)控制在65 mm Hg左右。监测并记录达到目标血压的时间以及麻醉前、麻醉中、控制性降压中、手术结束后的HR、MAP、SpO2;观察控制性降压过程中心电图的变化;记录控制性降压过程中意识恢复时间、拔管时间以及术后躁动发生率。同步采集桡动脉血和颈内静脉血行血气分析,测定动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、颈内静脉血氧分压(PjvO2)、颈内静脉血氧饱和度(SjvO2)、血红蛋白(Hb),并计算动脉血氧含量(CaO2)、颈内静脉血氧含量(CjvO2)、动静脉血氧含量差(Da-jvO2)及脑氧摄取率(CERO2)。结果:两组在麻醉及手术各时点的HR、MAP和SpO2比较差异均无统计学意义(P>0.05),但SP组吸入七氟烷浓度低于S组(P<0.05)。两组均未有患者出现心电图改变及心率失常发生。两组意识恢复时间及拔管时间比较差异均无统计学意义(P<0.05)。S组拔除喉罩后出现心动过缓、躁动情况均明显高于SP组,差异有统计学意义(P<0.05)。两组中PaO2、SaO2和SjvO2在降压前、降压中、降压后均明显高于麻醉前(P<0.05),但两组间差异无统计学意义(P>0.05);降压前、降压中、降压后的CjvO2均显著低于麻醉前(P<0.05),但两组间差异无统计学意义(P>0.05);降压前、降压中、降压后的Da-jvO2和CERO2均显著低于麻醉前(P<0.05),且SP组明显低于S组(P<0.05)。结论:七氟烷复合丙泊酚麻醉在需控制血压的动脉瘤介入栓塞手术中优于单纯七氟烷吸入麻醉,七氟烷用量减少,停药后不会出现血压反跳,对心脏影响小,意识恢复和拔管快,清醒平稳未出现术后躁动等不良反应,能够更好地控制性降压和脑氧代谢,同时减少脑血流量;能够安全、有效地应用于介入手术控制性降压过程中。更多还原

【Abstract】 Objective:To investigate the effects of controlled decompression by inhalation anesthetics sevoflurane combined with propofol in patients with aneurysm interventional embolization operation.Method:55 patients with aneurysm implementation of interventional embolization were selected and divided into sevoflurane group(group S) and propofol combined with sevoflurane group(group SP).The mean arterial pressure(MAP) in the process control were controlled in 65 mm Hg.The time, and reach the target blood pressure before anesthesia were monitored and recorded; after anesthesia, the step-down, operation in HR, MAP, SpO2 were controlled. And the changes of electrocardiogram(ECG), in the process of controlling step-down presence of arrhythmia were observed, control step-down sevoflurane concentration was record; in the process of consciousness recovery time and extubation time and the incidence of postoperative agitation were compared. Synchronous collection and radial artery blood and internal jugular venous blood on blood gas analysis, the arterial blood oxygen partial pressure(PaO2), arterial blood oxygen saturation(SaO2), internal jugular venous blood oxygen partial pressure(PjvO2), internal jugular venous blood oxygen saturation(SjvO2), hemoglobin(Hb) were determined, and the artery blood oxygen content(CaO2), internal jugular venous blood oxygen content(CjvO2), arteriovenous difference of oxygen content(Da- jvO2) and cerebral oxygen uptake rate(CERO2) were calculated.Result: Compared with the group SP and the group S before anesthesia, anesthesia, controlling hypertension and surgery after the end of each point in HR, MAP, SpO2 and there were no significant difference(P>0.05), but the group SP inhaled sevoflurane concentration was lower than the group S(P<0.05). Two group were not electrocardiogram changed and arrhythmia. In the consciousness recovery time and extubation time, there were no significant difference between the two groups(P>0.05).After pulling a laryngeal mask, the bradycardia, agitation of the group S were significantly higher than the SP group, the difference were statistically significant(P<0.05). Two groups’ PaO2, SaO2 and SjvO2 before step-down, step-down during and after decompression were significantly higher than that of before anesthesia(P<0.05), but no statistical difference between the two groups(P>0.05); Buck, step-down before during and after decompression CjvO2 were significantly lower than before anesthesia(P<0.05), but no statistical difference between the two groups(P>0.05); Step-down before and after decompression, step-down Da-jvO2 and CERO2 anesthesia were significantly lower than before, and the SP group were lower than that in the group S(P<0.05), and the difference were statistically significant(P<0.05). Conclusion: Sevoflurane composite propofol anesthesia on the control of blood pressure of the aneurysms interventional embolization is better than that of pure sevoflurane inhalation anesthesia in the operation, the dosage of sevoflurane reduced, there will be no blood pressure rebound after the drug was stopped, small effects on the heart, consciousness recovery and extubation fast, clear smooth and does not appear adverse reactions such as postoperative agitation, to better the effect of controlling hypertension and cerebral oxygen metabolism, and also reduce cerebral blood flow, whice can be applied to a safe and effective in controlling in the process of decompression surgery.更多还原