七氟醚对缺血性脑血管病患者脑循环及代谢的影响。

Effects of sevoflurane on cerebral circulation and metabolism in patients with ischemic cerebrovascular disease.

作者信息

Kitaguchi K, Ohsumi H, Kuro M, Nakajima T, Hayashi Y

机构信息

Department of Anesthesiology, National Cardiovascular Center, Osaka, Japan.

出版信息

Anesthesiology. 1993 Oct;79(4):704-9. doi: 10.1097/00000542-199310000-00011.

DOI:10.1097/00000542-199310000-00011

PMID:8214748

Abstract

BACKGROUND

Sevoflurane is a newly developed volatile anesthetic that has a low blood-gas partition coefficient. The effects of sevoflurane on the cerebral circulation or metabolism in humans have not been studied. The authors examined the cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) during sevoflurane anesthesia. The carbon dioxide response and autoregulation of cerebral circulation were also examined.

METHODS

Ten patients with ischemic cerebrovascular disease undergoing extra-intracranial artery anastomosis were studied. Cerebral blood flow and CMRO2 were determined by the Kety-Schmidt method using argon. These procedures were performed during the inhalation of 33% N2O, 33% argon, and oxygen with 1.5% sevoflurane (0.88 minimum alveolar concentration). To examine the relationship of CBF to a change in PaCO2, CBF was measured repeatedly at steady state PaCO2, of 40, 35, and 45 mmHg. Furthermore, CBF was measured before and after an increase in mean arterial pressure (MAP) caused by intravenous infusion of methoxamine to determine the relationship between CBF and MAP.

RESULTS

Cerebral blood flow and CMRO2 were 28 +/- 4 ml x 100 g-1 x min-1 and 1.34 +/- 0.23 ml x 100 g-1 x min-1, respectively. Cerebral blood flow was found to vary directly with PaCO2 alteration. The slope of the regression line between PaCO2 and CBF was 1.29 ml x 100 g-1 x min-1 x mmHg-1. On the other hand, CBF was constant throughout the elevation of MAP with vasopressor.

CONCLUSIONS

Both carbon dioxide response and cerebral autoregulation were well maintained under 0.88 MAC sevoflurane anesthesia in patients with ischemic cerebrovascular disease.

摘要

背景

七氟烷是一种新研发的挥发性麻醉剂，具有较低的血气分配系数。七氟烷对人体脑循环或代谢的影响尚未得到研究。作者研究了七氟烷麻醉期间的脑血流量（CBF）和脑氧代谢率（CMRO2）。还检测了脑循环的二氧化碳反应和自动调节功能。

方法

对10例接受颅内外动脉吻合术的缺血性脑血管病患者进行研究。采用氩气通过凯蒂 - 施密特法测定脑血流量和CMRO2。这些操作在吸入33%氧化亚氮、33%氩气以及含1.5%七氟烷（0.88最低肺泡浓度）的氧气期间进行。为了检测CBF与动脉血二氧化碳分压（PaCO2）变化的关系，在PaCO2分别为40、35和45 mmHg的稳态下重复测量CBF。此外，在静脉输注甲氧明导致平均动脉压（MAP）升高前后测量CBF，以确定CBF与MAP之间的关系。

结果

脑血流量和CMRO2分别为28±4 ml·100 g-1·min-1和1.34±0.23 ml·100 g-1·min-1。发现脑血流量随PaCO2改变而直接变化。PaCO2与CBF之间回归线的斜率为1.29 ml·100 g-1·min-1·mmHg-1。另一方面，在使用血管升压药使MAP升高的过程中，CBF保持恒定。