[异氟烷-笑气或丙泊酚-笑气维持全身麻醉期间脑血管对二氧化碳的反应性。经颅多普勒测速的比较研究]

[Cerebrovascular reactivity to CO2 during general anesthesia maintained with either isoflurane-N2O or propofol-N2O. A comparative study by transcranial Doppler velocimetry].

作者信息

Salord F, Naous H, Rizk T, Guérin J M, Dailler F, Peillon D, Chacornac R

机构信息

Département d'Anesthésie-Réanimation, Hôpital Neurologique et Neurochirurgical Pierre-Wertheimer, Lyon-Montchat.

出版信息

Ann Fr Anesth Reanim. 1995;14(2):166-71.

PMID:7486274

Abstract

OBJECTIVES

To compare, using transcranial doppler velocimetry (TDV), the cerebral blood flow velocity and CO2 reactivity during general anaesthesia maintained with either isoflurane-N2O-O2(IF) or propofol-N2O-O2 (PF) in adults with a normal brain.

STUDY DESIGN

Nonrandomized controlled trial.

PATIENTS

Forty ASA I patients (mean age 41 +/- 13 yrs, 15 F/35 M) undergoing surgery of the lumbar spine in prone position. The first 20 were allocated into the IF group and the subsequent 20 into the PF group.

METHODS

General anaesthesia was induced with midazolam (0.05 mg.kg-1), phenoperidine (0.03 mg.kg-1), thiopentone (5 mg.kg-1), vecuronium (0.1 mg.kg-1) and maintained with N2O (50 vol %) and O2 (50 vol %) and either isoflurane (0.8 < Fet < 1 vol %) in IF group or propofol (6 mg.kg-1.h-1) in PF group. The vascular reactivity was assessed with velocimetry measurements (Angiodine DMS, with a probe transmitting a 2-MHz pulsed wave) of flow in the middle cerebral artery at a given PetCO2 (obtained by adjustments of VT) during systole (SV) and diastole (DV). Three measurements were made: at T1 (PetCO2 = 30 +/- 2 mmHg), at T2 (PetCO2 = 40 +/- 2) and at T3 (PetCO2 = 30 +/- 2 mmHg).

RESULTS

In the IF group, VS increased by +32% at T2 (P = 0.006) with an increase of + 3.4 %/1 mmHg of PetCO2. Similarly, in the PF group VS increased by + 31 % at T2 (P < 0.0001) with an increase of 2.9 %/1 mmHg of PetCO2. In both groups the VS returned to baseline values at T3. In the IF group, VD increased by + 66% at T2 (P < 0.0001), with an increase of + 7%/1 mmHg of PetCO2. Similarly in the PF group, VD increased by + 61% (P < 0.0001) with an increase of + 5.7%/1 mmHg of PetCO2. In both groups the VD returned to baseline values at T3.

CONCLUSIONS

During anaesthesia maintained with either isoflurane-N2O-O2 or propofol-N2O-O2, a change in PetCO2 results in similar changes in VS and VD. These anaesthetic agents preserve the cerebrovascular reactivity of the normal brain. The results of this study are in accordance with those obtained with other reference techniques in healthy volunteers. Transcranial doppler velocimetry can be a useful noninvasive tool of clinical research in neuroanaesthesia.

摘要

目的

采用经颅多普勒测速法（TDV），比较异氟烷 - N₂O - O₂（IF）或丙泊酚 - N₂O - O₂（PF）维持全身麻醉期间，正常大脑的成年患者的脑血流速度和二氧化碳反应性。

研究设计

非随机对照试验。

患者

40例美国麻醉医师协会（ASA）I级患者（平均年龄41±13岁，15名女性/35名男性），俯卧位行腰椎手术。前20例被分配至IF组，随后20例被分配至PF组。

方法

用咪达唑仑（0.05mg·kg⁻¹）、苯哌啶（0.03mg·kg⁻¹）、硫喷妥钠（5mg·kg⁻¹）、维库溴铵（0.1mg·kg⁻¹）诱导全身麻醉，IF组用N₂O（50体积%）和O₂（50体积%）以及异氟烷（0.8＜呼气末浓度＜1体积%）维持麻醉，PF组用N₂O（50体积%）和O₂（50体积%）以及丙泊酚（6mg·kg⁻¹·h⁻¹）维持麻醉。在特定呼气末二氧化碳分压（PetCO₂）（通过调整潮气量获得）时，用测速测量法（Angiodine DMS，带有发射2MHz脉冲波的探头）测量大脑中动脉收缩期（SV）和舒张期（DV）的血流，以此评估血管反应性。进行三次测量：在T1（PetCO₂ = 30±2mmHg）、T2（PetCO₂ = 40±2）和T3（PetCO₂ = 30±2mmHg）时。

结果

在IF组，T2时SV增加了32%（P = 0.006），PetCO₂每增加1mmHg，SV增加3.4%。同样，在PF组，T2时SV增加了31%（P＜0.0001），PetCO₂每增加1mmHg，SV增加2.9%。两组在T3时SV均恢复到基线值。在IF组，T2时DV增加了66%（P＜0.0001），PetCO₂每增加1mmHg，DV增加7%。同样，在PF组，DV增加了61%（P＜0.0001），PetCO₂每增加1mmHg，DV增加5.7%。两组在T3时DV均恢复到基线值。