脑氧饱和度监测在硝普钠控制性降压中的临床应用  

Clinical application of the cerebral oximetry in the induced hypotension with nitroprusside

作　　者：李宝伟[1] 米卫东[1] 

机构地区：[1]解放军总医院麻醉手术中心,北京100853

出　　处：《北京医学》2009年第10期584-587,共4页Beijing Medical Journal

摘　　要：目的探讨硝普钠控制性降压对不同年龄组患者脑氧饱和度的影响,及其降压的安全性。方法选择ASAⅠ～Ⅱ级、18～30岁(青年组)和60～85岁(老年组)的患者各15例,术中利用硝普钠将血压降至基础值下降30%、绝对值不低于80/45mmHg[平均动脉压(MAP)50mmHg]水平。观察两组降压前后不同时点的脑氧饱和度(rSO2)、动脉压(ABP)、心输出量(CO)和血气参数,比较rSO2的变化。结果两组降压均有效,与降压前比较,MAP明显下降(P<0.01);老年组降压前后的rSO2有显著性差异,青年组降压前后rSO2的改变无显著性差异;青年组脑灌注的自身调节在心脏表现为降压前后心输出量明显增加;两组降压前后血气参数无显著性差异。结论rSO2监测能有效地反映硝普钠控制性降压中患者脑氧供需平衡的改变,在MAP降至基础值30%的范围内,对青年人的控制性降压是安全的,老年人则有可能发生脑氧供需失衡。在老年人控制性降压中及时、准确、有效地监测是必不可少的。Objective To estimate the safety in the induced hypotension with nitroprusside by the change of regional cerebral oxygen saturation （rSO2） in young and old aged group. Methods Two groups were selected in the study, one of which was 18～30 years old and the other was 60～85 years old. Their rSO2,arterial blood pressure （ABP）, cardiac output （CO） were continuously monitored and recorded during perioperative period. The change of rSO2 in the induced hypotension with nitroprusside was observed. Results MAP was different before and after induced hypotension. There was a significant difference in old aged group in rSO2 before and after induced hypotension, the change in young agedgroup was tiny. The CO of the young aged group was different before and after induced hypotension. The parameter of blood gas had no difference before and after induced. Conclusions The rSO2 monitoring in the induced hypotension with nitroprusside is effective to cerebral oxygen balance.It is safe in the patient of young aged group when MAP decreased 30 percent from base pressure level, but the patient of old aged group need prompt and accurate method to monitor the change of cerebral oxygen balance.

关 键 词：控制性降压 脑氧饱和度 心输出量 

分 类 号：R614[医药卫生—麻醉学]