首页
期刊简介
编 委 会
期刊订阅
百年学会 医星璀璨
名院风范
学科风华
菁英风采
投稿须知
过刊浏览
联系我们
篇名
关键词
作者
作者单位
摘要
关键词
注册本刊作者
作者投稿查稿
专家远程审稿
编辑在线审稿
编务办公专区
主编办公专区
下载文档
《上海医学》审稿费代缴委托书
《上海医学》杂志2024年征订启事
《上海医学》期刊编审系统审稿专家使用手册
工作动态
03-05
《上海医学》杂志2024年度“春蕾杯”论文评比征文通知
06-14
创新驱动,培育人才—《上海医学》2021年度春蕾计划评审结果揭晓
01-21
《上海医学》期刊影响力指标和学科排名取得显著提升
01-20
《上海医学》恭祝大家新年快乐!
08-18
作废声明
联系方式
发行周期:
月刊
主管单位:
上海市卫生健康委员会
主办单位:
上海市医学会
编辑出版:
《上海医学》编辑部
联系地址:
上海市北京西路1623号
邮编:
200040
电话:
021-62178606
传真:
021-62178606
邮箱:
smasmj@shsma.org.cn
ISSN:
ISSN0253-9934
CN:
CN31-1366/R
收款账号:
1001255309008900719
账户名:
上海市医学会
开户行:
工商银行上海市静安寺支行
友情链接
上海市医学会
当前位置:首页 >
中度过度通气在静脉麻醉过程中增加脑乳酸外排的作用机制研究
Research of Mechanism of Brain Cerebral Lactate Efflux induced by Moderate Hyperventilation during Intravenous Anesthesia Increases
浏览(426) 下载(0)
DOI:
作者:
丁帅
DING Shuai
作者单位:
杭州市中医院
Hangzhou Hospital of Traditional Chinese Medicine
关键词:
静脉麻醉;过度通气;乳酸
Intravenous anesthesia; Hyperventilation; Lactate
摘要:
目的: 探讨患者在静脉麻醉过程中,中度过度通气可能会增加脑乳酸外排,并影响脑内的有氧代谢从而降低脑血流量的作用机制。方法:选取30例准备行冠状动脉介入术男性患者作为研究对象,进行对照交叉试验。患者经芬太尼或咪达唑仑随机静脉麻醉后,针对30和50 mmHg二氧化碳分压进行测量。终点为脑血流量、大脑中动脉血流速度,以及脑的氧、葡萄糖和乳酸代谢率。以氩气为惰性气体示踪剂,采用改良Kęty-Schmidt技术测量全脑的脑血流量。通过经颅多普勒超声检测大脑中动脉的脑血流速度。数据表示为均数(标准差)的形式表示,采用双侧配对t检验和单因素方差分析。 结果:中度过度通气显著减少大脑血流量、血流速度、大脑氧供应及颈静脉球氧气分压,分别为60%、41%、58%以及45%,而脑氧气和葡萄糖代谢率保持不变。然而,脑乳酸净流出量显著增加,从-0.38(2.18)增加至-2.41(2.43)μmol min−1 100 g−1。 结论:中度过度通气会导致经静脉麻醉的心血管疾病患者的脑乳酸净流出量显著增加,脑血流量和颈静脉球的氧分压明显减少,提示临床相关浓度的低碳酸血症可能会损害脑有氧代谢水平。
Objectives In order to study the mechanism of moderate hyperentilation which may affect aerobic metabolism in the brain to reduce cerebral blood flow in the process of intravenous anesthesia of the patients. Methods 30 male patients who were ready to have coronary artery surgeries were selected as the research objects, and controlled crossover trial was carried out. After patients randomly treated with fentanyl or midazolam undergoing intravenous anesthesia, partial pressures of 30 and 50 mmHg CO2 were measured. Endpoints were cerebral blood flow, blood flow velocity in the middle cerebral artery, and oxygen, glucose and lactic acid metabolism of the brain. Using argon as inert gas tracer, the whole brain cerebral blood flow was measured by the modified Kęty - Schmidt technology. Cerebral blood flow velocity of middle cerebral artery was detected by transcranial doppler ultrasonic. Data were represented as mean (SD), double side paired t test and single factor variance analysis were used for statistical analysis. Results Cerebral blood flow, blood flow, cerebral oxygen supply and oxygen partial pressure jugular vein ball were significantly reduced by moderate hyperentilation, as 60%, 41%, 58% and 41% respectively, while cerebral oxygen and glucose metabolism rate remains constant. However, net outflow of lactic acid in the brain increased significantly from -0.38 (2.18) to -2.41 (2.43) μmol min−1 100 g−1. Conclusions Net outflow of lactic acid caused by moderate hyperentilation in the brain of the patients with cardiovascular disease undergoing intravenous anesthesia was increased significantly, while cerebral blood flow and oxygen partial pressure of jugular vein ball were significantly reduced, suggesting that hypocapnia in clinical relevent levels could damage aerobic metabolism in the brain.
点击下载DOC全文