Department of Clinical Physiology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, 852-8588, Japan.
J Clin Anesth. 2011 Nov;23(7):527-33. doi: 10.1016/j.jclinane.2011.02.004.
To determine the mechanical upper airway properties and compensatory neuromuscular responses to obstruction during propofol anesthesia in the follicular and luteal phases of the menstrual cycle.
Prospective, randomized study.
University-affiliated hospital.
12 premenopausal female volunteers for studies of upper airway collapse throughout their menstrual cycle during the follicular phase (6 -10 days) and mid-late luteal phase (20 - 24 days).
The level of propofol anesthesia (1.5 - 2.0 μg/mL) required to suppress arousal responses was determined by Observer's Assessment of Alertness/Sedation scoring (level 2) and confirmed by bispectral index monitoring. Pressure-flow relationships were constructed to evaluate collapsibility (P(CRIT)) and up-stream resistance (R(US)) during acute [Passive; hypotonic electromyography (EMG)] and sustained (Active; elevated EMG) changes in nasal mask pressure. The difference between passive P(CRIT) and active P(CRIT) (ΔP(CRIT A-P)) represented the magnitude of the compensatory response to obstruction.
Passive P(CRIT) was significantly higher in the mid-late luteal phase (-4.7 cm H(2)O) than in the follicular phase (-6.2 cmH(2)O; P < 0.05). Active P(CRIT) significantly decreased compared with passive P(CRIT) in the follicular phase (-10.1 cm H(2)O) and in the mid-late luteal phase (-7.7 cm H(2)O) and (P < 0.05). No significant difference was noted in ΔP(CRIT) between the follicular (3.9 ± 2.9 cm H(2)O) and mid-late luteal phases (3.0 ± 2.6 cm H(2)O). No differences were seen in R(US) between the menstrual phases for either the passive (P = 0.8) or active (P = 0.75) states.
Menstrual phase has an effect on anatomical alterations (mechanical properties) in the hypotonic upper airway during propofol anesthesia.
确定在卵泡期和黄体中期月经周期中，异丙酚麻醉时上呼吸道的力学特性以及对上呼吸道阻塞的补偿性神经肌肉反应。
前瞻性、随机研究。
大学附属医院。
12 名绝经前女性志愿者，在卵泡期（6-10 天）和中晚期黄体期（20-24 天）期间研究上呼吸道塌陷的整个月经周期。
通过观察者警觉/镇静评分（2 级）确定抑制觉醒反应所需的异丙酚麻醉水平，并通过双谱指数监测确认。构建压力-流量关系以评估急性[被动；低张力肌电图（EMG）]和持续（主动；升高的 EMG）鼻罩压力变化时的塌陷性（P(CRIT)）和上游阻力（R(US)）。被动 P(CRIT)和主动 P(CRIT)之间的差异（ΔP(CRIT A-P)）代表对上呼吸道阻塞的补偿反应的幅度。
中晚期黄体期的被动 P(CRIT)（-4.7cmH(2)O）明显高于卵泡期（-6.2cmH(2)O；P<0.05）。卵泡期和中晚期黄体期的主动 P(CRIT)与被动 P(CRIT)相比均显著降低（-10.1cmH(2)O 和-7.7cmH(2)O）（P<0.05）。卵泡期（3.9±2.9cmH(2)O）和中晚期黄体期（3.0±2.6cmH(2)O）之间的ΔP(CRIT)无显著差异。无论是被动状态（P=0.8）还是主动状态（P=0.75），两个月经周期之间的 R(US)均无差异。
月经周期对上呼吸道的机械特性有影响，这在上呼吸道在异丙酚麻醉期间发生张力性改变时表现明显。
