控制性降压对颅内动脉瘤夹闭术中脑氧饱和度和术后神经认知功能的影响  

Effect of controlled hypotension on intraoperative cerebral oxygen saturation and postoperative neural cognitive function in patients with intracranial aneurysm clipping

作　　者：吴姗姗[1] 李锦汶 梅凤美[1] 王宁[1] 马正良[2] WU Shanshan;LI Jinwen;MEI Fengmei;WANG Ning;MA Zhengliang(Department of Anesthesiology,Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院麻醉科,210029 [2]南京医科大学鼓楼临床医学院麻醉科

出　　处：《临床麻醉学杂志》2019年第10期941-944,共4页Journal of Clinical Anesthesiology

摘　　要：目的研究近红外光谱监测下两种控制性降压方式对颅内动脉瘤夹闭术中脑氧饱和度(rSO2)和术后神经认知功能的影响。方法选择行颅内动脉瘤夹闭术患者108例,男50例,女58例,年龄30~74岁,ASAⅠ或Ⅱ级,随机分为硝酸甘油降压组(N组)、七氟醚降压组(S组)和非降压组(C组),每组36例。N组和S组在开始剥离动脉瘤时开始控制性降压,于动脉瘤夹闭后停止降压。记录诱导前(T0)、开始降压时(T1)、降压后10 min(T2)、30 min(T3)、停止降压即刻(动脉瘤夹闭完成,T4)、停止降压后10 min(T5)、30 min(T6)、手术结束时(T7)和拔管时(T8)的rSO2。分别于术前和术后1、3、7 d采用简易精神状态量表(MMSE)和蒙特利尔认知功能评估量表(MoCA)评估患者认知功能。术后3个月随访并记录新发神经系统并发症及重要脏器并发症的情况。结果与T0时比较,T2-T6时N组和S组rSO2明显降低(P<0.05)。T2-T6时N组和S组rSO2明显低于C组(P<0.05)。N组和S组不同时点rSO2差异无统计学意义。三组不同时点MMSE评分及MoCA评分差异无统计学意义。三组术后并发症发生率差异无统计学意义。结论颅内动脉瘤夹闭术中应用七氟醚和硝酸甘油行控制性降压会降低脑氧饱和度,但不影响术后3个月内的神经认知功能。Objective To investigate the effects of controlled hypotension with two different drugs on intraoperative regional oxygen saturation(rSO2)and postoperative cognitive function in intracranial aneurysm clipping.Methods A total of 108 patients with intracranial aneurysm clipping surgery,50 males and 58 females,aged 30-74 years,falling into ASA physical statusⅠorⅡ,were selected and randomly divided into three groups(n=36):nitroglycerin group(group N),sevoflurane group(group S)and control group(group C).Controlled hypotension was started in groups N and S when exposuring aneurysm,and stopped after aneurysm clipped.rSO2 was recorded before induction(T0),at the beginning of controlling hypotension(T1),10 min(T2),30 min(T3)after controlling began,controlling stopped(clip finished,T4),10 min(T5),30 min(T6)after controlling stopped,at the end of operation(T7),and after extubation(T8).Cognitive function of 1 d before operation and 1,3 and 7 d after operation were recorded by using Mini Mental State Scale(MMSE)and Montreal Cognitive Function Assessment Scale(MoCA).The postoperative new neurological complications and important organ complications were recorded and the patients were followed up 3 months after operation.Results Compared with T0,rSO2 in groups N and S were significantly lower at T2-T6(P<0.05).Compared with group C,rSO2 in groups N and S were significantly lower at T2-T6(P<0.05).There was no significant difference of rSO2 between groups N and S at different time points.There was no significant difference of MMSE score and MoCA score of the three groups at different time points.Also there was no significant difference in the incidence of complications in the three groups.Conclusion In the intracranial aneurysm clipping,controlling hypotension with nitroglycerin and sevoflurane can reduce rSO2,but it does not affect cognitive function within three months after surgery.

关 键 词：动脉瘤夹闭术 控制性降压 脑氧饱和度 神经认知功能 

分 类 号：R614[医药卫生—麻醉学] R651.12[医药卫生—外科学]