Ederberg S, Westerlind A, Houltz E, Svensson S E, Elam M, Ricksten S E
Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden.
Anesth Analg. 1998 Jun;86(6):1201-6. doi: 10.1097/00000539-199806000-00011.
We investigated the effects of burst-suppression doses of propofol on cerebral blood flow velocity (CBFV), cerebral oxygen extraction (COE), and dynamic autoregulation in 20 patients undergoing cardiac surgery. The experimental procedure was performed during nonpulsatile cardiopulmonary bypass (CPB) with stable hypothermia (32 degrees C) in fentanyl-anesthetized patients. Middle cerebral artery transcranial Doppler flow velocity, right jugular bulb oxygen saturation, and jugular venous pressure (JVP) were continuously measured. Dynamic autoregulation was tested by stepwise changes in mean arterial pressure (MAP) within a range of 40-80 mm Hg by sodium nitroprusside and phenylephrine before (control) and during propofol infusion, with a stable plasma concentration (approximately 9 microg/mL). Propofol induced a 35% decrease in CBFV (P < 0.0001) and a 10% decrease in COE (P < 0.05) compared with control. The slopes of the curves relating CBFV and COE to cerebral perfusion pressure (CPP = MAP - JVP) were less pronounced with propofol (P < 0.01 and P < 0.05, respectively). We conclude that propofol decreases CBFV and improves dynamic autoregulation during moderate hypothermic CPB. Furthermore, during propofol infusion, cerebral blood flow was in excess relative to oxygen demand, as indicated by the decrease in COE.
In this study, we evaluated the effects of propofol on continuously measured cerebral blood flow velocity (CBFV) and cerebral oxygen extraction as a function of perfusion pressure. Propofol induced 35% and 10% decreases in CBFV and cerebral oxygen extraction, respectively. The slope of the curve relating cerebral perfusion pressure to CBFV decreased with propofol.
我们研究了丙泊酚爆发抑制剂量对20例接受心脏手术患者的脑血流速度（CBFV）、脑氧摄取（COE）和动态自动调节的影响。实验过程在芬太尼麻醉的患者中，于非搏动性体外循环（CPB）期间、稳定低温（32℃）下进行。连续测量大脑中动脉经颅多普勒血流速度、右颈静脉球血氧饱和度和颈静脉压力（JVP）。在丙泊酚输注前（对照）和输注期间，通过硝普钠和去氧肾上腺素在40 - 80 mmHg范围内逐步改变平均动脉压（MAP）来测试动态自动调节，血浆浓度稳定（约9μg/mL）。与对照相比，丙泊酚使CBFV降低35%（P < 0.0001），使COE降低10%（P < 0.05）。丙泊酚作用下，CBFV和COE与脑灌注压（CPP = MAP - JVP）相关曲线的斜率变平缓（分别为P < 0.01和P < 0.05）。我们得出结论，丙泊酚在中度低温CPB期间可降低CBFV并改善动态自动调节。此外，在丙泊酚输注期间，如COE降低所示，脑血流量相对于氧需求过多。
在本研究中，我们评估了丙泊酚对连续测量的脑血流速度（CBFV）和作为灌注压函数的脑氧摄取的影响。丙泊酚分别使CBFV和脑氧摄取降低35%和10%。丙泊酚使脑灌注压与CBFV相关曲线的斜率降低。
