Mashimo T, Zhang P, Kamibayashi T, Inagaki Y, Ohara A, Yamatodani A, Yoshiya I
Department of Anesthesiology, Osaka University Medical School, Suita City, Japan.
Anesth Analg. 1997 Aug;85(2):291-8. doi: 10.1097/00000539-199708000-00009.
The aim of the present study was to evaluate whether a sudden decrease in skin blood flow measured using a laser Doppler velocimeter reflects sympathetic nervous response to surgical skin incision during halothane (n = 17) and isoflurane (n = 16) anesthesia in 33 ASA physical status I or II patients scheduled for laparotomy. Plasma norepinephrine concentrations in the responding patients who showed a sudden decrease in the skin blood flow after surgical incision increased significantly and continued to increase 1-10 min after skin incision under halothane and isoflurane anesthesia. Although plasma norepinephrine concentrations in the nonresponders did not increase after surgical incision with halothane, the concentrations increased significantly at 1 min, but not at 3 and 10 min, after skin incision with isoflurane. The results indicate that the sudden decrease in laser Doppler flow reflects the sympathetic response to surgical incision. However, these also suggest that the factors that control the skin blood flow may not be simply sympathetic but may reflect other modulators as well. Plasma epinephrine concentration increased during skin incision, but the concentrations did not differ between the patients with and without a sudden decrease in skin blood flow. Increases in systolic blood pressure and rate-pressure product on skin incision were also significantly more in patients with skin blood flow response compared with those without the response. The magnitude of changes in plasma norepinephrine concentration and hemodynamic variables with skin incision was greater with isoflurane than with halothane at the same minimum alveolar anesthetic concentration level.
本研究的目的是评估在33例拟行剖腹手术的ASA身体状况I或II级患者中，使用激光多普勒血流仪测量的皮肤血流突然减少是否反映了氟烷（n = 17）和异氟烷（n = 16）麻醉期间对手术皮肤切口的交感神经反应。在氟烷和异氟烷麻醉下，手术切口后皮肤血流突然减少的反应性患者的血浆去甲肾上腺素浓度显著升高，并在皮肤切口后1 - 10分钟持续升高。虽然氟烷手术切口后无反应者的血浆去甲肾上腺素浓度没有增加，但异氟烷手术切口后1分钟浓度显著增加，而在3分钟和10分钟时没有增加。结果表明，激光多普勒血流的突然减少反映了对手术切口的交感神经反应。然而，这些结果也表明，控制皮肤血流的因素可能不仅仅是交感神经，也可能反映其他调节因子。皮肤切口期间血浆肾上腺素浓度升高，但皮肤血流突然减少和未减少的患者之间浓度没有差异。与无反应的患者相比，有皮肤血流反应的患者在皮肤切口时收缩压和心率 - 压力乘积的增加也显著更多。在相同的最低肺泡麻醉浓度水平下，异氟烷麻醉时手术切口引起的血浆去甲肾上腺素浓度和血流动力学变量的变化幅度比氟烷更大。
