| Objective:To study the changes of cerebral blood flow and intracranial pressure of the middle cerebral artery in gynecological laparoscopic surgery under sevoflurane or propofol combined with remifentanil and the influencing factors provides a reference for brain protection during anesthesia.Methods:Patients undergoing selective laparoscopic operation(n=0)in the Department of Gynaecology were enrolled in the study.Patients were randomly divided into sevoflurane combined with remifentanil group(S group,n=30)and propofol combined with remifentanil group(P group,n=30).After entering the operating room,an intravenous line was opened on one side,and invasive artery monitoring was established at the radial artery on the other side.After the patient’s blood pressure and heart rate were stable,the 2MHz monitoring probe of Transcranial Doppler(TCD)was placed on the left temporal window of the patien’s head.Probe was fixed with headband,after the strongest MCA blood flow signal was detected in a depth of 45-60mm,and measured the mean peak cerebral blood flow velocity(Vmean)and pulastility index(PI).Patients in the S group were given sevoflurane and remifentanil,and patients in the P group were given propofol and remifentanil for induction and maintenance of anesthesia.The mean arterial pressure(MAP),heart rate(HR),pressure of arterial carbon dioxide(PaCO2),pressure of end-tidal carbon dioxide(PETCO2),mean peak velocity(Vmean)of cerebral blood flow(CBF)and pulsatility index(PI)were observed at the following 8 time points:supine position before induction(T0),before endotracheal intubation(T1),before pneumoperitoneum(T2),5 min after pneumoperitoneum(T3),5 min after pneumoperitoneum and Trendelenberg position(T4),10 min after pneumoperitoneum and Trendelenberg position(T5),30 min after pneumoperitoneum and Trendelenberg position(T6),5 min after pneumoperitoneum degassing and position recovery(T7).Result:1.Compared with T0,MAP and HR in the two groups decreased at T1,T2 and T7(P<0.05),without significant difference in MAP and HR between T0 and T3-T6(P>0.05),and there was no obvious difference in MAP and HR between the two groups at different time points(P>0.05).2.Compared with T2,there was no significant difference from two groups of PaCo2 and PETCO2 at T3,T4,T5 and T7(P>0.05).T6 was higher than T5 and there was significant difference(P<0.05).3.P group:Vmean decreased at T1 and T2,which was significantly different from T0(P<0.01);T3,T4,T5 and T6 gradually increased,and there was no significant difference among T3,T4,T5 and T0(P>0.05),and T6 was significant difference from T5(P<0.05);It was decreased at T7 and significantly different from T0(P<0.01),and there was no significant difference between T1 and T2.S group:There is no significant difference between T1 and T0(P>0.05);Vmean decreased at T2,which was significantly different from T0(P<0.01);T3,T4,T5 and T6 gradually increased,and there was no significant difference among T3,T4,T5 and T0(P>0.05),and T6 was significant difference from T5(P<0.05);It was decreased at T7 and significantly different from T0(P<0.01),and there was no significant difference from T2(P>0.05).Comparing with two groups,group S is higher than group P at T1(P<0.01).4.P group:PI decreased at T1 and T2,which was significantly different from T0(P<0.01);T3,T4 and T5 gradually increased,and there was no significant difference between T3 and T0(P>0.05);T4,T5 and T6 was significantly different from T0(P>0.01);and T6 was significant difference from T5(P<0.05);It was decreased at T7 and significantly different from T0(P<0.01),and there was no significant difference between T1 and T2.S group:There was no significant difference between T1 and T0 in PI(P>0.05);PI decreased at T2,which was significantly different from T0(P<0.01);T4,T5 and T6 was significantly different from T0(P>0.01);and T6 was significant difference from T5(P<0.0.5);It was decreased at T7 and significantly different from T0(P<0.01),and there was no significant difference from T2.Comparing with two groups,group S is higher than group P at T1(P<0.01).Conclusion:1.During the induction period of anesthesia,the effect of induced sevoflurane combined with remifentanil on cerebral blood flow and intracranial pressure was significantly less than that of propofol combined with remifentanil.2.Clinical doses of propofol and sevoflurane in the maintenance period of anesthesia reduced cerebral blood flow and intracranial pressure.3.In gynecologic endoscopic anesthesia,CO2,pneumoperitoneum pressure and Trendelenberg position increased cerebral blood volume and intracranial pressure. |
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