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脑干手术中自主呼吸静脉麻醉下脑氧的供需 |
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周晓莉 张淑珍 王恩真
摘要 目的：观察脑干实质肿瘤切除术中全凭静脉麻醉及自主呼吸变化对脑氧供需平衡状态的影响。方法：全部患者均采用保留自主呼吸全麻插管，0.2%利多卡因、0.4%异丙酚混合液及1%氯胺酮行静脉麻醉维持，Spont或SIMV方式保证通气，于诱导前、诱导后、锯颅骨、取肿瘤、术毕分别抽取动脉及颈内静脉球部血行血气分析，根据Fick公式计算CaO２、CjvO2及C（a-jv）O２值，同步记录MAP、HR、CVP、RR、MV。结果：全部患者术中血流动力学稳定，其RR、MV明显降低，PaCO２升高、pHa下降；CaO２、SaO２始终保持在较高水平且稳定，SjvO２升高、CjvO２增加、C（a-jv）O２值下降。结论：脑干实质肿瘤切除术中保留自主呼吸行静脉麻醉，虽其呼吸变化导致PaCO２升高、pHa下降，但并未影响其脑氧供需平衡，此方法在临床上是可行的。
关键词 脑干 肿瘤 呼吸，自主 麻醉，静脉内 代谢 脑
Brain oxygen supply-demand balance status in patients with total intravenous anesthesia and spontaneous respiration during brain stem neoplasm surgery Zhou Xiaoli，Zhang Shuzhen，Wang Enzhen．Department of Anesthesiology，Beijing Tiantan Hospital，Capital University of Medical Science，Beijing 100050
Abstrct Objective：To observe the effects of total intravenous anesthesia（TIVA）and spontaneous respiration on brain oxygen balance status in patients undergoing brain stem neoplasm resection．Method：Thirty patients，ASA grade Ⅰ-Ⅱ，received endotracheal intubation with spontaneous respiration and TIVA．TIVA was maintained with intravenous 0.2% lidocaine 2-3 mg．kg-1．h-1，0．4％ propofol 4-6 mg．kg-1．h-1and 1％ ketamine 1-1．5 mg．kg-1．h-1．Arterial and jugular bulb blood samples were taken before and after induction，sawing skull and removing trmor seperately to analyse blood gas ．According to Fick principle，the level of CaO２，CjvO２ and C（a-jv）O２ were calculated．Result：The hymodynamics，SaO２ and CaO２ remained stable during whole procedure．In comparison with the baselines， respiratory rate， minute volume，arterial blood pH and C（a-jv）O２ were decreased，and PaCO２，SjvO２ and CjvO2 were increased significantly （P＜0.01)．Conclusion：TIVA with spontaneous respiration has on influence on cerebral oxygen supply-demand balance ，which is clinically feasible．
Key words Brain stem Neoplasm Respiration，spontaneous Anesthesia，intravenous Metabolism Brain
脑干实质肿瘤切除术，保留自主呼吸静脉麻醉，其脑氧供需平衡状态在国内文献尚无报道。本文通过观察30例脑干实质肿瘤患者术中SaO２、SjvO２、CaO２、[1] [2] [3] 下一页
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