多功能经颅骨颅内穿刺针持续颅内压监测指导颅脑创伤手术丙泊酚麻醉用量  

Intracranial pressure monitoring guides the dose of propofol in anesthesia for craniocerebral trauma patients

作　　者：袁鹏[1] 雍浩川 王佳[1] 唐彦明[1] 邹胜伟[1] 陈菲[1] 赫凌峰 王恩琴[3] 陶国才[3] 

机构地区：[1]重庆市急救医疗中心神经外科,重庆400014 [2]吉林省吉林市中西医结合医院麻醉科,吉林吉林132001 [3]第三军医大学西南医院麻醉科,重庆400014

出　　处：《第三军医大学学报》2018年第1期82-85,共4页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81171034);重庆市卫计委医学科研重点项目(2013-1-041)~~

摘　　要：目的探讨以自行设计的"多功能经颅骨颅内穿刺针(专利号:ZL 2008 2 0100454.6)"持续颅内压监测,指导颅脑创伤手术丙泊酚全身麻醉的临床效果。方法采用前瞻性随机对照研究设计,筛选重庆市急救中心2013年5月至2016年8月68例颅脑创伤手术患者。其中男性37例,女性31例,年龄(46.3±25.8)岁,体质量(63.7±5.6)kg。按随机数字表法分为常规组和试验组(n=34),根据动态监测脑灌注压(cerebral perfusion pressure,CPP)和颅内压(intracranial pressure,ICP)以调整丙泊酚使用。术前利用多功能经颅骨颅内穿刺针行快速颅内压监测颅内压(ICP)、脑灌注压(CPP);比较两组患者麻醉前(T0)、诱导后(T1)、手术1 h(T2)、手术2 h(T3)、手术结束前10 min(T4)患者SBP、DBP、MAP、ICP、CPP的变化。结果在麻醉诱导前两组SBP、DBP、MAP、ICP、CPP指数均无明显差异(P>0.05);在T2和T3,常规组SBP、DBP、MAP、ICP、CPP下降的程度相对于试验组更加显著(P<0.05)。结论多功能经颅骨颅内穿刺针在颅脑创伤手术中可有效地监测ICP、CPP改变并能指导丙泊酚的使用,有一定的临床推广价值。Objective To guide the dose of propofol for anesthesia in craniocerebral trauma patients by selfdesigned multifunctional transcranial puncture for intracranial pressure monitoring. Methods A prospective randomized controlled study was designed on 68 patients with craniocerebral trauma. They were randomly divided into the conventional group and the experimental group （n=34）, with cerebral perfusion pressure （CPP） and intracranial pressure （ICP） to guide the dose of propofol before operation. The changes of ICP, CPP, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, and mean arterial pressure （MAP） before anesthesia （T0）, in induction （T1）, 1 h after operation （T2）, 2 h after operation （T3）, and 10 min before the end of surgery （T4） were measured and compared between the 2 groups. Results There were no significant differences in SBP, DBP, MAP, ICP and CPP between the 2 groups before anesthesia induction （P〉0.05）. At T2 and T3, SBP, DBP, MAP, ICP and CPP were declined more significantly in the conventional group than the experimental group （P〈0.05）. Conclusion Our designed multifunctional transcranial puncture can effectively monitor ICP and CPP and guide the dose of propofol for craniocerebral trauma patients. It is worthy of further clinical promotion.

关 键 词：丙泊酚 颅脑创伤 诱导时间 颅内压 脑灌注压 

分 类 号：R612[医药卫生—外科学] R614.2[医药卫生—临床医学]