轻度过度通气对幕上占位开颅患者麻醉后颅内压、脑灌注压以及血流动力学影响  

The influence of mild hyperventilation to intracranial pressure、cerebral perfusion pressure and hemodynamics during supratentorial craniotomy

作　　者：陈一丁[1] 张宏伟[1] 唐育民[1] 张兆辉[1] 罗江辉[1] 

机构地区：[1]四川省肿瘤医院麻醉科,四川成都610041

出　　处：《四川医学》2011年第8期1186-1189,共4页Sichuan Medical Journal

摘　　要：目的观察轻度过度通气对幕上占位开颅患者麻醉后颅内压、脑灌注压以及血流动力学的影响,为临床上合理的神经外科麻醉方法提供依据。方法对21例幕上占位开颅患者给予轻度过度通气,控制呼吸末CO2 30～35mmHg和气道峰压10～18cmH2O,在全麻诱导前至开硬脑膜后这一时间段,分析经腰段脑脊液监测颅内压、经上腔静脉监测中心静脉压、经膀胱监测腹腔压、经有创动脉监测平均动脉压以及脑灌注压变化。结果轻度过度通气显著增高了全麻后患者中心静脉压,膀胱压和颅内压,降低了平均动脉压和脑灌注压。结论麻醉正压通气后应尽快开颅减压,降低颅内压,避免脑灌注压过度下降。轻度过度通气未表现出对脑灌注的有利影响,对于麻醉后应采用的控制呼吸策略还有待于进一步的对比研究。Objective To observe the influence of mild hyperventilation to intracranial pressure（ICP）、cerebral perfusion pressure（CPP） and hemodynamic during supratentorial craniotomy,and to provide evidence for applicable neurosurgical anesthesiology.Methods 21 patients with supratentorial tumor were given mild hyperventilation,with EtCO2 30～35mmHg and peak airway pressure 10～18cmH2O.The ICP through lumbar cerebrospinal fluid pressure,the central venous pressure（CVP） in superior vena cava,the intra-abdominal pressure（IAP） through intra-bladder pressure（IBP）,the mean arterial pressure（MAP） by peripheral arterial cannulation,and CPP were analyzed during the period from anesthesia induction to opening the hard meninges.Results The mild hyperventilation significantly increased the CVP、IBP and ICP,while significantly decreased the MAP and CPP in patients under anesthesia.Conclusion It＇s essential to remove skull bone flap to decrease ICP as soon as possible after anesthesia and positive ventilation,to prevent the abrupt decreasing of CPP.The mild hyperventilation doesn＇t provide beneficial effects to cerebral perfusion,and further comparative study for ventilation strategy should be designed.

关 键 词：过度通气 颅内压 脑灌注压 血流动力学 

分 类 号：R614[医药卫生—麻醉学]