Afonas'ev M G, Kislukhina E V, Makarevich A V, Bondarenko A N, Mikhaĭlov I P, Timerbaev V Kh
Anesteziol Reanimatol. 2014 Jul-Aug;59(4):14-9.
To compare effects of isoflurane, sevoflurane and target concentration of propofol on the systemic hemodynamics, cerebral blood flow and cerebral oximetry of the brain during the carotid endarterectomy.
We studied 95 patients. The patients were divided into 3 groups. Group I included 26 patients who received isoflurane (under I MAC), Group II--40 patients who received sevoflurane (under I MAC), Group III--29 patients who received target concentration of propofol (under 4 mkg/ml) according to the method of Schneider Studied parameters were defined at the stages: before the operation (I), after the induction (II), after the intubation (III), during the separation of the carotid artery (IV), after the crossclamping of the carotid artery (V), before starting the bloodstream (VI), after starting of the bloodstream (VII), after the end of the operation (VIII).
At the first stages of the operation, the using of isoflurane, sevoflurane and propofol was accompanied with moderate dose-dependent lowering of indicators ofcirculatory dynamics. The linear blood flow velocity (LBFV) in the middle cerebral artery on the affected side in the groups of isoflurane and propofol did not depend on the indicators ofcirculatory dynamics; in the sevoflurane group the correlation was traced During the breakoff of the blood circulation in the reconstructed carotid arteries while using the anesthesia of isoflurane, sevoflurane and propofol hemodynamics was stable. LBFV and cerebral oximetry (CO) in the groups of isoflurane and propofol did not depend on the systemic hemodynamics; in the sevoflurane group--they depended After the reinitiating of the bloodstream in the conditions of the isoflurane andpropofol anesthesia the reperfusion of the brain was moderate; in the conditions of the sevoflurane anesthesia the risk of reperfusion damage of the brain during the uncontrolled hypertension remained. At the stage of finishing the operation LBFV and CO did not depend on the systemic hemodynamics in the isoflurane and propofol groups, in the sevoflurane group the dependence was indicated. Consequently, at all the stages of the operation we indicated the disorder of the mechanisms of the brain blood supply autoregulation in the sevoflurane group.
比较异氟烷、七氟烷和丙泊酚目标浓度对颈动脉内膜切除术期间全身血流动力学、脑血流量和脑血氧饱和度的影响。
我们研究了95例患者。患者被分为3组。第一组包括26例接受异氟烷（1 MAC以下）的患者，第二组——40例接受七氟烷（1 MAC以下）的患者，第三组——29例根据施奈德方法接受丙泊酚目标浓度（4微克/毫升以下）的患者。研究参数在以下阶段定义：手术前（I）、诱导后（II）、插管后（III）、颈动脉分离期间（IV）、颈动脉夹闭后（V）、开始血流前（VI）、开始血流后（VII）、手术结束后（VIII）。
在手术的第一阶段，使用异氟烷、七氟烷和丙泊酚伴随着循环动力学指标的中度剂量依赖性降低。异氟烷组和丙泊酚组患侧大脑中动脉的线性血流速度（LBFV）与循环动力学指标无关；在七氟烷组中发现了相关性。在使用异氟烷、七氟烷和丙泊酚麻醉重建颈动脉期间血液循环中断时，血流动力学稳定。异氟烷组和丙泊酚组的LBFV和脑血氧饱和度（CO）与全身血流动力学无关；在七氟烷组中——它们相关。在异氟烷和丙泊酚麻醉条件下重新开始血流后，脑再灌注适度；在七氟烷麻醉条件下，在未控制的高血压期间存在脑再灌注损伤的风险。在手术结束阶段，异氟烷组和丙泊酚组的LBFV和CO与全身血流动力学无关，七氟烷组显示出相关性。因此，在手术的所有阶段，我们都指出七氟烷组存在脑供血自动调节机制紊乱。
