【原】【罂粟摘要】丙泊酚和七氟醚对脑血管影响的比较：以数字减影血管造影参数评估的脑动脉瘤破裂患者的初步研究

丙泊酚和七氟醚对脑血管影响的比较：以数字减影血管造影参数评估的脑动脉瘤破裂患者的初步研究 

贵州医科大学       麻醉与心脏电生理课题组

翻译 :潘志军     编辑 :  严旭    审校 :   曹莹

背景：既往研究评估了挥发性和静脉麻醉药对脑血管的影响，结果不一致。我们使用数字减影血管造影（DSA）比较了丙泊酚和七氟醚对动脉瘤性蛛网膜下腔出血（aSAH）患者的脑血管内径和脑循环时间的影响。

方法：这是一项前瞻性初步研究，纳入了择期行血管内线圈栓塞术的成人高级别aSAH患者；患者随机接受丙泊酚或七氟醚麻醉进行血管内线圈栓塞术。主要结局是在3个时间点（清醒、麻醉诱导后和线圈栓塞术后）测量的7个脑血管段的内径，分别在受累侧和非受累侧的脑部测量。还测量了作为脑血流替代指标的脑循环时间。 

结果：18名患者纳入分析（每组9名）。基线和术中参数在两组间相似。丙泊酚在受累侧的1个血管段在诱导后和线圈栓塞术后增加了内径，非受累侧的1个血管段在线圈栓塞术后增加了内径（P<0.05）。七氟醚在受累侧的3个血管段在诱导后和2个血管段在线圈栓塞术后增加了内径，在非受累侧的4个血管段在线圈栓塞术后增加了内径（P<0.05）。两组间脑循环时间与基线清醒状态相比均无变化，也无差异。 

结论：与丙泊酚相比，七氟醚对高级别aSAH患者具有脑血管扩张作用。然而，七氟醚对脑循环时间的影响与丙泊酚相当。

原始文献来源：Steve Joys,Nidhi B. Panda, Chirag K. Ahuja,et al.Comparison of Effects of Propofol and Sevoflurane on the Cerebral Vasculature Assessed by Digital Subtraction Angiographic Parameters in Patients Treated for Ruptured Cerebral Aneurysm: A Preliminary Study[J]. (2023 Jul 1;35(3):327-332)

英文原文：

Comparison of Effects of Propofol and Sevoflurane on the Cerebral Vasculature Assessed by Digital Subtraction Angiographic Parameters in Patients Treated for Ruptured Cerebral Aneurysm: A Preliminary Study    

Abstract

Introduction: Studies have evaluated the effects of volatile and intravenous anesthetic agents on the cerebral vasculature with inconsistent results. We used digital subtraction angiography to compare the effects of propofol and sevoflurane on the luminal diameter of cerebral vessels and on cerebral transit time in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: This prospective preliminary study included adult patients with good-grade aSAH scheduled for endovascular coil embolization; patients were randomized to receive propofol or sevoflurane anesthesia during endovascular coiling. The primary outcome was the luminal diameter of 7 cerebral vessel segments measured on the diseased and nondiseased sides of the brain at 3 time points: awake, postinduction of anesthesia, and postcoiling. Cerebral transit time was also measured as a surrogate for cerebral blood flow.

Results: Eighteen patients were included in the analysis (9 per group). Baseline and intraoperative parameters were similar between the groups. Propofol increased the diameter of 1 vessel segment at postinduction and postcoiling on the diseased side and in 1 segment at postcoiling on the nondiseased side of the brain (P<0.05). Sevoflurane increased vessel diameter in 3 segments at postinduction and in 2 segments at postcoiling on the diseased side, and in 4 segments at postcoiling on the nondiseased side (P<0.05). Cerebral transit time did not change compared with baseline awake state in either group and was not different between the groups.

Conclusions: Sevoflurane has cerebral vasodilating properties compared with propofol in patients with good-grade aSAH. However, sevoflurane affects cerebral transit time comparably to propofol.