Jansen G F, van Praagh B H, Kedaria M B, Odoom J A
Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, The Netherlands.
Anesth Analg. 1999 Aug;89(2):358-63. doi: 10.1097/00000539-199908000-00021.
We investigated, in brain tumor patients, the jugular bulb venous oxygen partial pressure (PjO2) and hemoglobin saturation (SjO2), the arterial to jugular bulb venous oxygen content difference (AJDO2), and middle cerebral artery blood flow velocity (Vmca) during anesthesia, and the effect of hyperventilation on these variables. Twenty patients were randomized to receive either isoflurane/ nitrous oxide/fentanyl (Group 1) or propofol/fentanyl (Group 2). At normoventilation (PacO2 35 +/- 2 mm Hg in Group 1 and 33 +/- 3 mm Hg in Group 2), SjO2 and PjO2 were significantly higher in Group 1 than in Group 2 (SjO2 60% +/- 6% and 49% +/- 13%, respectively; P = 0.019) (PjO2 32 +/- 3 and 27 +/- 5 mm Hg, respectively; P = 0.027). In Group 2, 5 of 10 patients had SjO2 < 50%, and 3 of these patients had SjO2 < 40% and AJDO2 > 9 mL/dL. All patients in Group 1 had SjO2 > 50%. During hyperventilation, there were no differences in SjO2, PjO2, or AJDO2 between the two groups. On hyperventilation, there was no correlation between the relative decreases of Vmca and 1/AJDO2 (r = 0.21, P = 0.41). The results indicate during propofol anesthesia, half of the brain tumor patients showed signs of cerebral hypoperfusion, but not during isoflurane/nitrous oxide anesthesia. Furthermore, during PacO2 manipulations, shifts in Vmca are inadequate to evaluate brian oxygen delivery in these patients.
During propofol anesthesia at normoventilation, 50% of brain tumor patients showed signs suggesting cerebral hypoperfusion, but this could not be demonstrated during isoflurane/nitrous oxide anesthesia. During PacO2 manipulations, consecutive measurements of the cerebral blood flow velocity may be inadequate to assess cerebral oxygenation.
我们对脑肿瘤患者在麻醉期间的颈静脉球部静脉血氧分压（PjO2）和血红蛋白饱和度（SjO2）、动脉血与颈静脉球部静脉血氧含量差（AJDO2）以及大脑中动脉血流速度（Vmca）进行了研究，并观察了过度通气对这些变量的影响。20例患者被随机分为两组，分别接受异氟烷/氧化亚氮/芬太尼（第1组）或丙泊酚/芬太尼（第2组）麻醉。在正常通气时（第1组动脉血二氧化碳分压[PacO2]为35±2 mmHg，第2组为33±3 mmHg），第1组的SjO2和PjO2显著高于第2组（SjO2分别为60%±6%和49%±13%；P = 0.019）（PjO2分别为32±3 mmHg和27±5 mmHg；P = 0.027）。在第2组的10例患者中，有5例SjO2<50%，其中3例SjO2<40%且AJDO2>9 mL/dL。第1组所有患者的SjO2>50%。在过度通气期间，两组之间的SjO2、PjO2或AJDO2没有差异。过度通气时，Vmca的相对降低与1/AJDO2之间没有相关性（r = 0.21，P = 0.41）。结果表明，在丙泊酚麻醉期间，一半的脑肿瘤患者出现脑灌注不足的迹象，但在异氟烷/氧化亚氮麻醉期间未出现。此外，在PacO2操作期间，Vmca的变化不足以评估这些患者的脑氧输送情况。
在正常通气的丙泊酚麻醉期间，50%的脑肿瘤患者出现提示脑灌注不足的迹象，但在异氟烷/氧化亚氮麻醉期间未得到证实。在PacO2操作期间，连续测量脑血流速度可能不足以评估脑氧合情况。
