麻黄碱与去氧肾上腺素对麻醉状态脑肿瘤患者脑血流量和耗氧量的影响
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麻黄碱与去氧肾上腺素对麻醉状态脑肿瘤患者脑血流量和耗氧量的影响
翻译：任文鑫 编辑：冯玉蓉 审校：曹莹
背景：对麻醉病人的研究表明，与麻黄碱相比，去氧肾上腺素能降低局部脑血氧饱和度。本研究旨在量化去氧肾上腺素和麻黄碱对脑肿瘤患者脑血流量和脑氧代谢率的影响。我们假设与麻黄碱相比，去氧肾上腺素降低了某些大脑区域的脑氧代谢率。
方法：在这项双盲随机临床试验中，24名麻醉状态的脑肿瘤患者随机接受麻黄碱或去氧肾上腺素治疗。在血管活性药输注前和输注过程中，对瘤周和对侧正常脑半球的脑血流量和脑氧代谢率进行正电子发射断层扫描。主要观察指标是组间脑氧代谢率的差异。次要观察指标包括脑血流量、氧摄取率和局部脑氧饱和度的变化。
结果：血管活性药输注前后瘤周平均±SD脑氧代谢率组间无差异(麻黄碱 67.0±11.3和67.8±25.7μmol·100 g−1·min−1；去氧肾上腺素 68.2±15.2和67.6±18.0μmol·100 g−1·min−1) (95%CI 1.5[−13.3~16.3]μmol·100 g−1·min−1[P=0.839])。相应的对侧脑半球的脑氧代谢率无组间差异(麻黄碱 90.8±15.9和94.6±16.9μmol·100 g−1·min−1；去氧肾上腺素，100.8±20.7和96.4±17.7μmol·100 g−1·min−1) (95%CI 8.2[−2.0~18.5]μmol·100 g−1·min−1[P=0.118])。与去氧肾上腺素相比，麻黄碱显著增加对侧脑半球的脑血流量(95%CI 3.9[0.7-7.0]ml.100 g-1.min-1[P=0.019])和局部脑血氧饱和度(95%CI 4[1-8]%[P=0.024])。瘤周和对侧脑半球的氧摄取率变化无统计学差异(瘤周差异[95%CI] −0.6[−14.7~13.6]%[P=0.0.934]；对侧半球差异[95%CI]，−0.1[−12.1~12.0]%[P=0.0.989])。
结论：麻黄碱和去氧肾上腺素治疗的患者瘤周和对侧正常脑半球的脑氧代谢率相似。与去氧肾上腺素相比，麻黄碱可增加对侧正常脑半球的脑血流量和局部脑氧饱和度。
文献来源：Koch KU, Mikkelsen IK, Aanerud J, et al.Ephedrine versusPhenylephrine Effect on Cerebral Blood Flow and Oxygen Consumption in Anesthetized Brain Tumor Patients.[J].ANESTHESIOLOGY 2020; 133:304–17.
Ephedrine versus Phenylephrine Effect on Cerebral Blood Flow and Oxygen Consumption in Anesthetized Brain Tumor Patients
Abstract
Background: Studies in anesthetized patients suggest that phenylephrine reduces regional cerebral oxygen saturation compared with ephedrine. The present study aimed to quantify the effects of phenylephrine and ephedrine on cerebral blood flow and cerebral metabolic rate of oxygen in brain tumor patients. The authors hypothesized that phenylephrine reduces cerebral metabolic rate of oxygen in selected brain regions compared with ephedrine.
Methods: In this double-blinded, randomized clinical trial, 24 anesthetized patients with brain tumors were randomly assigned to ephedrine or phenylephrine treatment. Positron emission tomography measurements of cerebral blood flow and cerebral metabolic rate of oxygen in peritumoral and normal contralateral regions were performed before and during vasopressor infusion. The primary endpoint was between-group difference in cerebral metabolic rate of oxygen. Secondary endpoints included changes in cerebral blood flow, oxygen extraction fraction, and regional cerebral oxygen saturation.
Results: Peritumoral mean ± SD cerebral metabolic rate of oxygen values before and after vasopressor (ephedrine, 67.0 ± 11.3 and 67.8 ± 25.7 μmol · 100 g−1 · min−1; phenylephrine, 68.2 ± 15.2 and 67.6 ± 18.0 μmol · 100 g−1· min−1) showed no
intergroup difference (difference [95% CI], 1.5 [−13.3 to 16.3] μmol · 100 g−1 · min−1 [P = 0.839]). Corresponding contralateral hemisphere cerebral metabolic rate of oxygen values (ephedrine, 90.8 ± 15.9 and 94.6 ± 16.9 μmol · 100 g−1 · min−1; phenylephrine, 100.8 ± 20.7 and 96.4 ± 17.7 μmol · 100 g−1 · min−1) showed no intergroup difference (difference [95% CI], 8.2 [−2.0 to 18.5] μmol · 100 g−1 · min−1 [P = 0.118]). Ephedrine significantly increased cerebral blood flow (difference [95% CI], 3.9 [0.7 to 7.0] ml · 100 g−1 · min−1 [P = 0.019]) and regional cerebral oxygen saturation (difference [95% CI], 4 [1 to 8]% [P=0.024]) in the contralateral hemisphere compared to phenylephrine. The change in oxygen extraction fraction in both regions (peritumoral difference [95% CI], −0.6 [−14.7 to 13.6]% [P = 0.934]; contralateral hemisphere difference [95% CI], −0.1 [− 12.1 to 12.0]% [P = 0.989]) were comparable between groups.
Conclusions: The cerebral metabolic rate of oxygen changes in peritumoral and normal contralateral regions were similar between ephedrine- and phenylephrine-treated patients. In the normal contralateral region, ephedrine was associated with an increase in cerebral blood flow and regional cerebral oxygen saturation compared with phenylephrine.
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