摘要
目的 评价低流量吸入地氟醚或异氟醚控制性降压对患儿压力反射敏感性（BRS）的影响。方法 30例脊柱侧凸女性患儿，ASAⅠ或Ⅱ级，随机分为地氟醚组（D组）和异氟醚组（Ⅰ组）（n=15）。采用低流量吸入技术，逐渐增大吸入浓度使平均动脉压（MAP）控制在55～65mmHg。分别在诱导前（L）、气管插管后即刻（T1）、呼气末麻醉药浓度达到1MAC即刻（T2）、体位改为俯卧位后即刻（L）、血压达到目标值范围30min时（T4）测定心血管BRS。结果 与R相比，两组患儿其余各时点BRS均降低（P〈0．05）；与T1相比，两组患儿T1、T，BRS增高（P〈0．05）；与T2比较，两组患儿T3BRS差异无统计学意义（P〉0．05），T4BRS降低（P〈0．05）；与T3比较，两组患儿T4BRS降低（P〈0．05）；D组患儿改变体位后达到目标血压的时间短于Ⅰ组（P〈0．01）。结论 低流量吸入地氟醚或异氟醚控制性降压可剂量依赖性的抑制患儿BRS，安全有效地实施控制性降压。
Objective To evaluate the effects of controlled hypotension induced by closed-circuit low flow anesthesia with desflurane and isoflurane on baroreflex sensitivity （BRS） in children. Methods Thirty female ASA Ⅰ or Ⅱ patients aged 13-16 yr undergoing elective scoliosis surgery were randomly assigned to one of two groups （n = 15 each） ： desflurane group and isoflurane group. Anesthesia was induced with midazolam 0.04 mg/kg , fentanyl 2 μg/kg and propofol 2 mg/kg . Tracheal intubation was facilitated with rocuronium 1 mg/kg . The patients were mechanically ventilated. Anesthesia was maintained with closed-circuit low flow anesthesia with either desflurane or isoflurane. Cardiovascular baroreflex sensitivity was measured according to Bowers EJ et al. The changes in R-R interval on ECG and the corresponding systolic BP within 5 min after intravenous phenylephrine 50- 100 μg which increased SBP by 20-30 mm Hg were analyzed before induction of anesthesia （T0）, immediately after induction of anesthesia （%）, when end-tidal inhalational anesthetic concentration reached IMAC （T2）, immediately after the patients were placed in the prone position （T3 ） and 30 min after target hypotension （ MAP 55-65 mm Hg） was achieved （T4）.Results The two groups were comparable with respect to demographic variables including age, body weight, duration of operation, body temperature, intraoperative blood loss, blood transfusion and fluid infusion. There was no significant difference in BRS between the 2 groups. The BRS was significantly depressed at T1-4 as compared with the baseline at T0 BRS was depressed to the utmost at Ta when the end-tidal desflurane/isoflurane concentration was 1.6 MAC. Conclusion Inhalational anesthetics administered in closedcircuit depress BRS in a dose-dependent manner.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第2期133-135,共3页
Chinese Journal of Anesthesiology
