本文選題：靜脈麻醉 + 過度通氣�。� 參考：《上海醫(yī)學(xué)》2015年06期

【摘要】：目的探討中度過度通氣在靜脈麻醉過程中增加腦乳酸外排、影響腦內(nèi)有氧代謝從而降低腦血流量的作用機(jī)制。方法選取30例準(zhǔn)備行冠狀動(dòng)脈介入治療的男性患者作為研究對象,進(jìn)行對照交叉試驗(yàn)。患者經(jīng)芬太尼或咪達(dá)唑侖隨機(jī)靜脈麻醉,手術(shù)前分別在動(dòng)脈血二氧化碳分壓≥50和25~30 mmHg(1mmHg=0.133kPa,即通氣不足和中度過度通氣狀態(tài))時(shí)檢測血流動(dòng)力學(xué)和代謝指標(biāo)并進(jìn)行計(jì)算。結(jié)果中度過度通氣狀態(tài)下的動(dòng)脈血二氧化碳分壓、腦血流量、大腦中動(dòng)脈平均血流速度、有效的腦灌注壓、頸靜脈球靜脈血氧飽和度、頸靜脈血氧分壓、腦氧供、乳酸-氧指數(shù)和乳酸-葡萄糖指數(shù)均顯著低于通氣不足時(shí)(P值均0.01),平均動(dòng)脈壓、腦零流量壓力、腦血管阻力、動(dòng)脈血pH值、動(dòng)脈血氧飽和度、動(dòng)脈血氧分壓、乳酸腦代謝率、氧攝取分?jǐn)?shù)均顯著高于通氣不足時(shí)(P值分別0.01、0.05),氧的動(dòng)脈-靜脈差異、葡萄糖的動(dòng)脈-頸靜脈差異、乳酸的動(dòng)脈-頸靜脈差異均顯著大于通氣不足時(shí)(P值均0.01)。中度過度通氣與通氣不足狀態(tài)下血紅蛋白水平、血液溫度、氧腦代謝率和葡萄糖腦代謝率的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論中度過度通氣會(huì)導(dǎo)致行靜脈麻醉的心血管疾病患者的腦乳酸凈流出量顯著增加,腦血流量和頸靜脈球血氧分壓顯著降低,提示臨床相關(guān)濃度的低碳酸血癥可能會(huì)損害腦有氧代謝水平。
[Abstract]:Objective to investigate the mechanism of increasing brain lactate efflux and decreasing cerebral blood flow by moderate pass ventilation during intravenous anesthesia. Methods 30 male patients undergoing coronary intervention were selected as subjects. Patients were randomly anesthetized by fentanyl or midazolam. Hemodynamic and metabolic parameters were measured and calculated at arterial blood carbon dioxide partial pressure 鈮，

本文編號：2097964