丙泊酚麻醉下脑氧供需平衡和大脑自动调节平台及其影响因素的研究

傅俊豪; 陈妍; 杨纯勇; 鲁开智

doi:10.16016/j.2097-0927.202205161

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丙泊酚麻醉下脑氧供需平衡和大脑自动调节平台及其影响因素的研究

临床医学 | 更新时间：2026-01-09

- 丙泊酚麻醉下脑氧供需平衡和大脑自动调节平台及其影响因素的研究
- Brain oxygen supply-demand balance and cerebral autoregulatory plateau under propofol anesthesia and influencing factors
- 陆军军医大学学报 2022年44卷第18期页码：1845-1855
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
  
  [ 鲁开智，E-mail:lukaizhi2010@163.com LU Kaizhi, E-mail: lukaizhi2010@163.com
- 基金信息：
  
  国家自然科学基金青年科学基金(81601569)
- DOI：10.16016/j.2097-0927.202205161
  中图分类号： R331.37;R338.2;R614.1
- 收稿：2022-05-30，
  
  修回：2022-07-28，
  
  纸质出版：2022-09-30
- 稿件说明：
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傅俊豪, 陈妍, 杨纯勇, 等. 丙泊酚麻醉下脑氧供需平衡和大脑自动调节平台及其影响因素的研究[J]. 陆军军医大学学报, 2022,44(18):1845-1855.

Junhao FU, Yan CHEN, Chunyong YANG, et al. Brain oxygen supply-demand balance and cerebral autoregulatory plateau under propofol anesthesia and influencing factors[J]. Journal of Army Medical University, 2022, 44(18): 1845-1855.
傅俊豪, 陈妍, 杨纯勇, 等. 丙泊酚麻醉下脑氧供需平衡和大脑自动调节平台及其影响因素的研究[J]. 陆军军医大学学报, 2022,44(18):1845-1855. DOI： 10.16016/j.2097-0927.202205161.

Junhao FU, Yan CHEN, Chunyong YANG, et al. Brain oxygen supply-demand balance and cerebral autoregulatory plateau under propofol anesthesia and influencing factors[J]. Journal of Army Medical University, 2022, 44(18): 1845-1855. DOI： 10.16016/j.2097-0927.202205161.

摘要

目的

探讨丙泊酚在静脉麻醉前后的脑氧供需平衡是否存在差异以及脑氧供需平衡和大脑自动调节平台的影响因素。

方法

选取2020年6-10月于我院肝胆外科行开腹手术的53例患者，观测从入手术室至手术结束期间的局部脑氧饱和度(regional cerebral oxygensaturation

rSO

)、脑组织血红蛋白浓度指数(cerebral tissue hemoglobin concentration index

THI)、平均动脉压(mean arterial pressure

MAP)。采用rSO

以及THI评价脑的氧合情况。然后计算整个手术过程中rSO

与MAP之间的移动线性Pearson相关系数，即COx，计算THI与MAP之间的移动线性Pearson相关系数，即THx。利用COx和THx探讨大脑自动调节的上下限和平台长度。间断采集血气分析，患者都采用标准化麻醉管理。

结果

左右两侧脑rSO

在麻醉前和麻醉后差异有统计学意义(左侧

0.001，右侧

0.001)；左右两侧脑THI在麻醉前和麻醉后差异有统计学意义(左侧

0.001，右侧

0.001)。左右侧rSO

和THI分别根据年龄、是否阻断肝门和手术时长分组比较差异都无统计学意义(

0.05)。线性相关曲线显示左右脑THI随着年龄的增长有逐渐下降的趋势(左脑THI随年龄变化趋势

=-0.261 8，

=0.058 3;右脑THI随年龄变化趋势

=-0.283 6，

=0.039 6)。丙泊酚静脉麻醉下由COx界定脑血流自动调节下限、上限和调节范围分别为(81.98±12.63)、(93.67±13.69)、(11.22±8.38)mmHg。由THx界定脑血流自动调节下限、上限和调节范围分别为(79.96±10.61)、(93.77±12.34)、(13.79±8.63)mmHg。由COx和THx界定的CA上限、下限和调节范围根据年龄是否大于50岁、是否阻断肝门和手术时长是否大于360 min进行分组比较，差异无统计学意义(

0.05)。

结论

丙泊酚麻醉后会降低患者左右脑rSO

和THI，左右脑THI受到年龄影响，脑血流自动调节的下限、上限以及自动调节范围不受年龄是否大于50岁、是否阻断肝门和手术时长是否大于360 min影响。

Abstract

Objective

To investigate the differences in brain oxygen supply-demand balance before and after intravenous anesthesia with propofol

and determine the influencing factors of the balance and cerebral autoregulation plateau.

Methods

A total of 53 patients undergoing open hepatobiliary surgery in our hospital from June 2020 to October 2020 were enrolled in this study. Their local regional cerebral oxygen saturation (rSO

)

cerebral tissue hemoglobin concentration index (THI) and mean arterial pressure (MAP) were monitored and recorded from entering the operating room to the end of the operation. Brain oxygenation was assessed using rSO

as well as using THI. Then the moving linear Pearson correlation coefficient between rSO

and MAP was calculated and named as Cox

and the moving linear Pearson correlation coefficient between THI and MAP was also calculated and named as THx. The upper and lower limits and range of cerebral autoregulation (CA) were studied using COx and THx. Intermittent sampling of blood was performed for blood gas analysis. All patients underwent standardized anesthesia management.

Results

There were significant differences in rSO

in the left and right brain before and after anesthesia (left:

0.001

right:

0.001)

so were in THI in the left and right sides before and after anesthesia (left:

0.001

right:

0.001). There were no statistical differences in the left and right rSO

and THI among those at different ages

with the porta hepatis being blocked or not

and with different operation durations (

0.05). Linear correlation curve showed that the THI values of the left and right brain were decreased with age (left:

=-0.261 8

=0.058 3; right:

=-0.283 6

=0.039 6). Under propofol intravenous anesthesia

COx

defined the lower limit

upper limit and range of CA were 81.98±12.63

93.67±13.69 and 11.22±8.38 mmHg

respectively. THx defined the lower limit

upper limit and range of CA was 79.96±10.61

93.77±12.34 and 13.79±8.63 mmHg

respectively. No obvious differences were seen in the upper limit

lower limit and adjustment range of CA defined by COx and THx among those with the age is older than 50 years or not

porta hepatis being blocked or not

and longer than 360 min or not (

0.05).

Conclusion

Propofol anesthesia can induce declined rSO

and THI values in the left and right brain. The left and right cerebral THI is affected by age

while the lower limit

upper limit and range of CA are not affected by the age older than 50 years

the porta hepatis being blocked or not

and the operation time longer than 360 min or not.

关键词

Keywords

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