血管内降温对颅内动脉瘤切除术患者围术期脑损伤的影响  

Effect of endovascular cooling on perioperative brain injury in patients undergoing intracranial aneurysm resection

作　　者：王志萍[1] 王凤祥[2] 陈红生[2] 虞政权[3] 于如同[3] 

机构地区：[1]南京医科大学附属无锡市人民医院麻醉科,214023 [2]江苏省麻醉学重点实验室 [3]徐州医学院附属医院神经外科

出　　处：《中华麻醉学杂志》2010年第12期1416-1419,共4页Chinese Journal of Anesthesiology

基　　金：江苏省卫生厅资助项目（H200723）;江苏省医学重点人才资助项目（RC2007093）;江苏省高校自然科学重大基础研究项目（08KJA320001）

摘　　要：目的 探讨血管内降温对颅内动脉瘤切除术患者围术期脑损伤的影响。方法拟行颅内动脉瘤切除术的患者16例，年龄18～64岁，性别不限，Hunt．Hess分级Ⅱ～Ⅳ级，病程〈14d，随机分为2组（n=8）：浅低温组（MHT组）及常温组（NT组）。MHT组麻醉诱导后行股静脉穿刺，置入CL-2295AE三腔降温导管，连接起动套件，并设置膀胱温度为34℃，达目标温度后维持24h。于术中、术后记录血液动力学指标，于术前24h、术后12和24h测定凝血功能和电解质水平；于术前1d及术后1、3和7d采用ELISA法测定血清神经元特异性烯醇化酶（NSE）和S100B浓度；术后1、3个月时采用GOS分级评价神经功能。结果低温期间MHT组血液动力学指标均维持在正常范围，与NT组比较差异无统计学意义（P〉0．05）；与NT组比较，MHT组GOS分级升高，术后血清NSE和S100B蛋白浓度降低（P〈0．05），电解质水平和凝血功能各指标差异无统计学意义（P〉0．05）。结论血管内降温可安全有效地减轻颅内动脉瘤切除术患者围术期的脑损伤，改善预后。Objective To investigate the effect of endovascular cooling on perioperative brain injury in patients undergoing intracranial aneurysm resection. Methods Sixteen Hunt-Hess Ⅱ -Ⅳ patients of both sexes aged 18-64 yr undergoing intracranial aneurysm resection were randomly divided into 2 groups （ n = 8 each） ： mild hypothermia group （group MHT） and normothermia group （group NT）. A CL-2295AE catheter was placed in the femoral vein after anesthesia induction to perform endovascular cooling. Bladder temperature was reduced to 34 ℃ and maintained for 24 h. The hemodynamic parameters were recorded during and after operation. Coagnlantion function and electrolyte levels were determined at 24 h before operation and at 12 and 24 h after operation. The serum neuron-specific enolase （NSE） and S100B concentrations were determined at 1 d before operation and at 1, 3 and 7 d after operation by ELISA. Neurological function was assessed with GOS grade at 1 and 3 months after operation. Results There was no significant difference in hemodynamic parameters, electrolyte levels （Na＋ , K＋ , Ca2 ＋ ） and coagulantion function （PT, APTF, Pit） between the two groups （ P 〉 0.05）. The GOS grade was significantly higher, while serum NSE and S100B concentrations were significantly lower after operation in group MHT than in group NT （ P 〈 0.05）. Conclusion Endovascular cooling （34℃, 24 h） can reduce the brain injury safely and effectively during the perioperative period in patients undergoing intracranial aneurysm resection and improve the prognosis.

关 键 词：低温 人工 颅内动脉瘤 脑损伤 

分 类 号：R614[医药卫生—麻醉学]