在七氟醚和异氟醚麻醉期间，手术切口引起的脑动静脉氧含量差的变化相似。

Changes in the cerebral arteriovenous oxygen content difference by surgical incision are similar during sevoflurane and isoflurane anaesthesia.

作者信息

Inada T, Shingu K, Uchida M, Kawachi S, Tsushima K, Niitsu T

机构信息

Department of Anesthesiology, Kansai Medical University Hospital, Osaka, Japan.

出版信息

Can J Anaesth. 1996 Oct;43(10):1019-24. doi: 10.1007/BF03011903.

DOI:10.1007/BF03011903

PMID:8896853

Abstract

PURPOSE

To investigate changes of cerebral arteriovenous oxygen content difference (AVDO2) induced by surgical incision and to determine carbon dioxide (CO2) reactivity of the cerebral circulation during sevoflurane and isoflurane anaesthesia.

METHODS

Twenty-one ASA 1-2 patients undergoing elective surgery for supratentorial tumours were randomly allocated to receive either 1.3 MAC sevoflurane/N2O anaesthesia (n = 10) or equi-MAC isoflurane/N2O anaesthesia (n = 11). Before and after incision, haemodynamic measurements and AVDO2 determinations were performed. After opening the dura, AVDO2 was determined before and after the respiration rate was increased by 50%.

RESULTS

Incision produced an increase in mean arterial pressure from 69 +/- 11 to 97 +/- 22 mmHg (mean +/- SD) (P < 0.0005) and from 71 +/- 6 to 89 +/- 12 mmHg (P < 0.0001) in the sevoflurane and isoflurane groups, respectively, whereas the heart rate increased from 60 +/- 9 to 72 +/- 8 bpm (P < 0.001) and from 65 +/- 6 to 70 +/- 7 bpm (P < 0.001), respectively. Arterial carbon dioxide tension (PaCO2) was increased from 33.6 +/- 2.3 to 34.6 +/- 1.8 mmHg (P < 0.05) with incision in the sevoflurane group. The AVDO2 was decreased from 6.5 +/- 1.6 to 5.3 +/- 1.6 vol% (P < 0.0005) in the sevoflurane group and from 6.7 +/- 1.1 to 6.0 +/- 1.1 vol% (P < 0.01) in the isoflurane group. The % change of AVDO2 was larger in the sevoflurane group than in the isoflurane group (-18.3 +/- 8.4% vs -9.1 +/- 9.0%; P < 0.05) but no difference remained after the post-incisional AVDO2 value of the sevoflurane group was corrected for pre-incisional PaCO2. Carbon dioxide reactivity, calculated as the percent change in AVDO2 per mmHg change in PaCO2, was 6.1 +/- 3.0%.mmHg-1 in the sevoflurane group and 5.9 +/- 2.4%.mmHg-1 in the isoflurane group (P = NS).

CONCLUSIONS

Sevoflurane and isoflurane are associated with similar impairment of cerebral flow-metabolism coupling at incision, while CO2 reactivity is maintained during both anaesthetics.

摘要

目的

研究手术切口引起的脑动静脉氧含量差（AVDO2）变化，并确定七氟醚和异氟醚麻醉期间脑循环的二氧化碳（CO2）反应性。

方法

21例美国麻醉医师协会（ASA）1-2级择期行幕上肿瘤手术的患者被随机分为两组，分别接受1.3最低肺泡有效浓度（MAC）的七氟醚/N2O麻醉（n = 10）或等效MAC的异氟醚/N2O麻醉（n = 11）。在切口前后进行血流动力学测量和AVDO2测定。打开硬脑膜后，在呼吸频率增加50%前后测定AVDO2。

结果

在七氟醚组和异氟醚组中，切口分别使平均动脉压从69±11 mmHg升高至97±22 mmHg（平均值±标准差）（P < 0.0005）和从71±6 mmHg升高至89±12 mmHg（P < 0.0001），而心率分别从60±9次/分钟增加至72±8次/分钟（P < 0.001）和从65±6次/分钟增加至70±7次/分钟（P < 0.001）。七氟醚组切口后动脉血二氧化碳分压（PaCO2）从33.6±2.3 mmHg升高至34.6±1.8 mmHg（P < 0.05）。七氟醚组的AVDO2从6.5±1.6 vol%降至5.3±1.6 vol%（P < 0.0005），异氟醚组从6.7±1.1 vol%降至6.0±1.1 vol%（P < 0.01）。七氟醚组AVDO2的变化百分比大于异氟醚组（-18.3±8.4%对-9.1±9.0%；P < 0.05），但在七氟醚组切口后的AVDO2值校正切口前的PaCO2后，差异不再存在。以每mmHg PaCO2变化时AVDO2的变化百分比计算的二氧化碳反应性，七氟醚组为6.1±3.0%·mmHg-1，异氟醚组为5.9±2.4%·mmHg-1（P = 无统计学意义）。