严格血压管理策略对颈动脉内膜剥脱术术中脑氧供需平衡的影响  

Aggressive blood pressure management on regional cerebral oxygen saturation in patients undergoing carotid endarterectomy

作　　者：王云珍[1] 于斌[1] 韩如泉[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京100050

出　　处：《首都医科大学学报》2016年第4期529-533,共5页Journal of Capital Medical University

基　　金：北京市科委首都特色临床应用研究课题(Z141107002514123)~~

摘　　要：目的观察严格血压管理策略对颈动脉内膜剥脱术患者脑氧供需平衡的影响。方法择期行颈动脉内膜剥脱术患者20例,年龄49~75岁,术前测定基础血压。术中平均动脉压(mean arterial pressure,MAP)调控目标:阻断前(T1)期血压维持在基础血压水平;阻断(T2)期血压维持在基础血压的+10%^+20%水平,且SBP<160 mm Hg(1 mm Hg=0.133 k Pa);解除阻断(T3)期血压维持在基础血压的-10%^-20%范围。记录麻醉诱导前10 min(T_0)、手术后20 min(T_1)、颈动脉阻断即刻(T_2)、颈动脉阻断15 min(T3)、颈动脉开放即刻(T4)、颈动脉开放10 min(T5)、拔除气管插管后10 min(T6)时平均动脉压、脑电双频指数(bispectral index,BIS)和双侧脑氧饱和度(regional cerebral oxygen saturation,r SO2)。结果 T_0、T_1、T_2、T_3和T4时间点的MAP分别为(94±9)mm Hg、(94±14)mm Hg、(105±10)mm Hg、(102±14)mm Hg和(84±12)mm Hg,阻断期MAP较基础水平提升约11%(P<0.05),解除阻断后MAP较基础水平降低11%(P<0.05);术侧rSO_2在以上各时间点为(70±4)%、(65±3)%、(64±5)%、(67±4)%和(69±4)%,T2期的rSO_2较基础值降低(P<0.05),但T_2、T_3和T_4各时间点之间差异无统计学意义(P>0.05);同非术侧比较,术侧rSO2在T_3和T_4点明显降低(P<0.05)。手术侧及非手术侧颈动脉阻断前后rSO_2下降<20%。结论颈动脉内膜剥脱术中,严格的血压调控能维持患者良好的脑氧供需平衡,防止脑缺血的发生。Objective To assess the effect of aggressive blood pressure management on regional cerebral oxygen saturation（ r SO2） of patients undergone carotid endarterectomy（ CEA）. Methods A total of 20 patients,aged from 49 to 75 years old,undergone CEA were included in the study. The baseline for MAP was calculated the day before surgery. The strategy of aggressive blood pressure management include that MAP was kept at baseline value during preclamp phase,elevated 10%-20% of baseline value during cross-clamp phase with SBP no more than 160 mm Hg（ 1 mm Hg = 0. 133 k Pa） and then decreased 10%- 20% of baseline value after clamp removal.Intraoperative bispectral index（ BIS）,r SO2 monitoring were applied. The value of MAP,BIS and r SO2 were recorded at different points of the surgery. Results The MAP was elevated about 11% of baselinevalue during clamping phase（ P〈0. 05） and decreased about 11% of baseline value after clamp removal（ P〈0. 05）. The r SO2 value detected from ipsilateral brain was significantly decreased during the crossclamp phase（ P〈0. 05）,but the decreasing percentage in r SO2 was less than 20% from preclamp value to cross-clamp value. Then,the r SO2 was ameliorated to baseline value after clamp removal. Conclusion Aggressive blood pressure management is beneficial to improve r SO2 for the patients undergoing CEA and prevent incidence of cerebral ischemia.

关 键 词：颈动脉内膜剥脱术 脑氧饱和度 脑缺血 血压管理 

分 类 号：R614[医药卫生—麻醉学]