钙拮抗剂联合硝酸甘油降压对颅脑手术患者血流动力学的影响及对脑保护的作用  

Effect of Calcium antagonist combined with nitroglycerin on hemodynamics of patients with craniocerebral operationand its protection for brain

作　　者：宋晓阳[1] 牛迪 SONG Xiaoyang;NIU Di(Department of Anesthesia,The First Affiliated Hospital of Xi′an Medical University,Xi′an,Shaanxi,710077;Department of Functional Neurosurgery,Shangluo Central Hospital,Shangluo,Shaanxi,726000)

机构地区：[1]陕西省西安医学院第一附属医院麻醉科,陕西西安710077 [2]陕西省商洛市中心医院功能神经外科,陕西商洛726000

出　　处：《实用临床医药杂志》2018年第24期27-29,32,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨颅脑手术中应用钙拮抗剂联合硝酸甘油降压对血流动力学的影响及脑保护的作用。方法将本院60例择期行颅脑手术患者随机分为对照组和联合组,各30例。对照组术中给予常规降压药物硝酸甘油静脉滴注,联合组予钙拮抗剂联合硝酸甘油降压治疗。分别于控制性降压前即刻(T0)、降压30 min(T1)、停止控制性降压30 min(T2)监测平均动脉压(MAP)、动脉血氧含量(CaO2)、脑氧摄取率(ERO2)水平,术前和术后2周采用格拉斯哥昏迷评分(GCS)评估脑神经损伤程度。结果 2组T1时MAP均低于T0、T2时(P <0. 05); 2组各时点MAP比较差异均无统计学意义(P> 0. 05),2组均无术后动脉痉挛或术中低血压发生; 2组T0～T2时点CaO2差异无统计学意义(P> 0. 05),对照组T1时点ERO2较T0时点显著升高,联合组显著下降,2组比较差异有统计学意义(P <0. 05); 2组术后2周时GCS均较术前显著升高,且联合组较对照组升高更为显著(P <0. 05)。结论颅脑手术中应用钙拮抗剂联合硝酸甘油降压效果满意,血流动力学较稳定,能有效改善脑氧代谢和脑神经损伤。Objective To investigate the effect of Calcium antagonist combined with nitroglycerin on blood pressure,hemodynamics for craniocerebral surgery patients and its protection on brain.Methods A total of 60 patients undergoing craniocerebral operation in our hospital were randomly divided into control group and combined group,with 30 cases in each group.The control group was given intravenous drip of nitroglycerin,and the combined group was given intravenous drip of Calcium antagonist and nitroglycerin.Mean arterial pressure(MAP),arterial oxygen content(CaO 2),brain oxygen uptake rate(ERO 2)were monitored at the time points of T 0(immediately before controlled hypotension),T 1(30 minutes after hypotension)and T 2(30 minutes after discontinuation of controlled hypotension).The degree of brain nerve injury was assessed by Glasgow Coma Score(GCS)before and after 2 weeks of operation.Results MAP levels at T 1 in both groups were lower than that at T 0 and T 2(P<0.05).There was no significant difference in MAP levels between groups at three time points(P>0.05).There was no post-operative arterial spasm or intraoperative hypotension in both groups.CaO 2 at three time points in both groups had no significant change(P>0.05).ERO 2 at T 1 in the control group was significantly higher,and was significantly higher in the combined group than that at T 0(P<0.05).The GCS of the two groups increased significantly at 2 weeks after operation(P<0.05),and the combined group increased more significantly than the control group(P<0.05).Conclusion The application of Calcium antagonist combined with nitroglycerin in craniocerebral surgery achieved satisfactory antihypertensive efficacy and stable hemodynamics,and it can effectively improve cerebral oxygen metabolism and brain nerve injury.

关 键 词：颅脑手术 钙拮抗剂 硝酸甘油 血流动力学 脑保护作用 

分 类 号：R651.1[医药卫生—外科学]