颅内动脉瘤夹闭术中应用亚低温技术的临床观察  

Clinical observation of mild hypothermia during aneurysm clipping operation

作　　者：张彦[1] 

机构地区：[1]天津市环湖医院,天津300211

出　　处：《吉林医学》2013年第13期2436-2438,共3页Jilin Medical Journal

摘　　要：目的:研究亚低温对颅内动脉瘤夹闭术瞬间阻断及缺血再灌注期的脑保护作用。方法:选取行颅内动脉瘤夹闭术患者26例,随机抽取13例于动脉瘤夹闭瞬间阻断及缺血再灌注期行亚低温(5.7±2.9 h)处理。直肠温度(RT)控制在31.0℃～36.0℃,脑温为32.0℃～35.0℃。同时,监测患者的生命体征、颅内压(ICP)、血糖、血乳酸、血气、血电解质以及脑组织氧分压(PbrO2)、脑组织温度(BT)和失血量。对照组13例,直肠温度控制在36.0℃～37.2℃,其他治疗同亚低温组。两组患者均于术后3个月时根据GOS评估法判定疗效。结果:亚低温脑保护组手术完成顺利,术中ICP、血糖、血乳酸较对照组显著性降低,而PbrO2则显著性升高,差异有统计学意义(P<0.05或P<0.01)。生命体征、血气及血电解质比较,差异无统计学意义(P>0.05);无严重并发症;死亡率降低,运动神经功能良好率提高,预后显著改善。结论:亚低温确可明显降低颅内动脉瘤夹闭术患者的死亡率,提高患者的生命质量。Objective To study the effects of mild hypothermia on the patients during aneurysm clipping operation.Method There were 16 patients with aneurysm clipping operation from Sep 2010 to Jun 2012 in our hospital,we selected 13 cases that had been treated with mild hypothermia during operation,randomly.Hypothermia was induced within the time of operation.Rewarming was begun in the end of operation(average 5.7±2.9 hours) or after the rectal temperature(RT) reached 31.0-36.0℃ or the brain temperature(BT) reached 32.0-35.0℃.Meantime,the vital sign,intracranial pressure(ICP),blood sugar,blood gas values,blood electrolytes,brain tissue oxygen pressure(PbrO2) and brain tissue temperature(BT) and blood loss were measured.The rectal temperature of control,patients was induced to 36.0-37.2℃.According to Glasgow Outcome Scale(GOS),the prognosis of the patients was evaluated after 3 months.Results In comparison with control group,the operation in mild hypothermia group achieved successfully,during operation they were notably decreased in ICP,blood sugar,blood lactic acid and increased in PbrO2,respectively(P﹤0.05 or P﹤0.01).The vital sign,blood gas values and blood electrolytes did not significantly change and there was no severe complication happened.The mortality was decreased and good recovery cases were increased,the prognosis of the patients was improved.Conclusion Mild hypothermia can exactly reduce the mortality and improve the prognosis for the patients with aneurysm clipping operation.

关 键 词：亚低温 颅内动脉瘤 脑损伤 麻醉 

分 类 号：R743.3[医药卫生—神经病学与精神病学]