七氟醚对颅内压、脑血流量及脑代谢的影响。一项针对因脑肿瘤接受开颅手术患者的剂量反应研究。

Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism. A dose-response study in patients subjected to craniotomy for cerebral tumours.

作者信息

Bundgaard H, von Oettingen G, Larsen K M, Landsfeldt U, Jensen K A, Nielsen E, Cold G E

机构信息

Department of Neuroanaesthesiology, Aarhus University Hospital, Denmark.

出版信息

Acta Anaesthesiol Scand. 1998 Jul;42(6):621-7. doi: 10.1111/j.1399-6576.1998.tb05292.x.

DOI:10.1111/j.1399-6576.1998.tb05292.x

PMID:9689265

Abstract

BACKGROUND

Studies concerning the cerebrovascular effects of sevoflurane in patients with space-occupying lesions are few. This study was carried out as a dose-response study comparing the effects of increasing sevoflurane concentration (1.5% (0.7 MAC) to 2.5% (1.3 MAC)) on cerebral blood flow (CBF), intracranial pressure (ICP), cerebrovascular resistance (CVR), metabolic rate of oxygen (CMRO2) and CO2-reactivity in patients subjected to craniotomy for supratentorial brain tumours.

METHODS

Anaesthesia was induced with propofol/fentanyl/atracurium and maintained with 1.5% sevoflurane in air/oxygen at normocapnia. Blood pressure was maintained constant by ephedrine. In group 1 (n = 10), the patients received continuously 1.5% sevoflurane. Subdural ICP, CBF and CMRO2 were measured twice at 30-min intervals. In group 2 (n = 10), sevoflurane concentration was increased from 1.5% to 2.5% after CBF1. CBF2 was measured after 20 min during 2.5% sevoflurane. Finally, CO2-reactivity was studied in both groups.

RESULTS

In group 1, no time-dependent alterations in CBF, CVR, ICP and CMRO2 were found. In group 2, an increase in sevoflurane from 1.5% to 2.5% resulted in an increase in CBF from 29 +/- 10 to 34 +/- 12 ml 100 g-1 min-1 and a decrease in CVR from 2.7 +/- 0.9 to 2.3 +/- 1.2 mmHg ml-1 min 100 g (P < 0.05), while ICP and CMRO2 were unchanged. CO2-reactivity was maintained at 1.5% and 2.5% sevoflurane.

CONCLUSION

Sevoflurane is a cerebral vasodilator in patients with cerebral tumours. Sevoflurane increases CBF and decreases CVR in a dose-dependent manner. CO2-reactivity is preserved during 1.5% and 2.5% sevoflurane.

摘要

背景

关于七氟醚对占位性病变患者脑血管影响的研究较少。本研究作为一项剂量反应研究，比较了七氟醚浓度增加（从1.5%（0.7MAC）至2.5%（1.3MAC））对幕上脑肿瘤开颅手术患者脑血流量（CBF）、颅内压（ICP）、脑血管阻力（CVR）、氧代谢率（CMRO2）和二氧化碳反应性的影响。

方法

采用丙泊酚/芬太尼/阿曲库铵诱导麻醉，在正常二氧化碳分压下以1.5%七氟醚维持于空气/氧气混合气体中。通过麻黄碱维持血压恒定。在第1组（n = 10）中，患者持续接受1.5%七氟醚。硬膜下ICP、CBF和CMRO2每隔30分钟测量两次。在第2组（n = 10）中，在CBF1测量后七氟醚浓度从1.5%增加至2.5%。在2.5%七氟醚期间20分钟后测量CBF2。最后，在两组中研究二氧化碳反应性。

结果

在第1组中，未发现CBF、CVR、ICP和CMRO2随时间的变化。在第2组中，七氟醚从1.5%增加至2.5%导致CBF从29±10增加至34±12 ml 100g-1 min-1，CVR从2.7±0.9降至2.3±1.2 mmHg ml-1 min 100g（P < 0.05），而ICP和CMRO2未改变。在1.5%和2.5%七氟醚时二氧化碳反应性得以维持。