七氟醚和硝酸甘油控制性降压对颅内动脉瘤夹闭术患者的影响  

Effects of Controlled Hypotension with Sevoflurane and Nitroglycerin on Patients Undergoing Intracranial Aneurysm Clipping

作　　者：杨爱民 王宏伟[1] Yang Aimin;Wang Hongwei(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China)

机构地区：[1]郑州大学第一附属医院麻醉与围手术期医学部,郑州450000

出　　处：《成都医学院学报》2021年第1期20-23,共4页Journal of Chengdu Medical College

基　　金：河南省卫生和计划生育委员会项目(No:201602094)。

摘　　要：目的探讨七氟醚和硝酸甘油控制性降压对颅内动脉瘤夹闭术患者血流动力学、脑氧代谢和认知功能的影响。方法收集2017年6月至2019年10月择期接受颅内动脉瘤夹闭术92例患者作为研究对象,美国麻醉医师协会分级(ASA)为Ⅰ~Ⅱ级,术中剥离动脉瘤时开始实施控制性降压处理,夹闭后停止降压。采用简单随机分组法分为两组,其中46例术中选择血管扩张药硝酸甘油进行降压,记为硝酸甘油组(n=46),另外46例选择吸入性麻醉药七氟醚进行降压,记为七氟醚组(n=46),两组其他围手术期处理均相同。动态监测两组降压即刻(T0)、降压5 min(T1)、降压10 min(T2)、降压30 min(T3)、降压结束5 min(T4)、降压结束10 min(T5)平均动脉压(MAP)、心率(HR)和中心静脉压(CVP)水平;同时监测T0、T3和T5时点脑氧摄取率(CERO2)、脑氧饱和度(rSO2),术后3 d检测血清神经元特异性烯醇化酶(NSE)水平,并采用美国国立卫生研究院卒中量表(NIHSS)量表评估认知功能。结果两组均成功完成手术,无动脉瘤破裂发生。硝酸甘油组T1时点MAP、HR明显低于七氟醚组(P<0.05),T4时点MAP较T3时点明显升高(P<0.05),也明显高于七氟醚组(P<0.05),七氟醚组T4时点MAP较T3时点明显升高(P<0.05)。两组T3时点CERO2、rSO2水平均较T0时点明显下降(P<0.05),T5时点有明显回升(P<0.05),组间T0、T3、T5时点CERO2、rSO2水平比较差异均无统计学意义(P>0.05)。两组术后1、3 d血清NSE水平和术后3 d NIHSS评分比较差异无统计学意义(P>0.05)。结论七氟醚和硝酸甘油控制性降压均能明显改善动脉瘤夹闭术患者术中脑氧代谢,保护术后神经认知功能,相较而言,七氟醚对患者血流动力学的波动影响更小,降压和复压的平稳性更佳。Objective To investigate the effects of controlled hypotension with sevoflurane and nitroglycerin on hemodynamics,cerebral oxygen metabolism and cognitive function in patients undergoing intracranial aneurysm clipping.Methods A total of 92 patients underwent intracranial aneurysm clipping surgery at selected time from June 2017 to October 2019 were included in the study.The surgery was carried out under the American Society of Anesthesiologists(ASA)gradesⅠtoⅡ,during which the controlled hypotension was initiated when the aneurysm was dissected and stopped after clipping.Patients were divided into two groups by simple random grouping method.Nitroglycerin group(n=46)was given vasodilator nitroglycerin for controlled hypotension,while sevoflurane group was given sevoflurane,an inhaled anesthetic,for controlled hypotension.Other perioperative treatments were the same in both groups.The mean arterial pressure(MAP),heart rate(HR),and central venous pressure(CVP)in both groups were dynamically monitored immediately(T0),5 min(T1),10 min(T2),and 30 min(T3)after the implementation of controlled hypotension,and 5 min(T4)and 10 min(T5)after the stop of controlled hypotension.Cerebral oxygen extraction ratio(CERO2),and cerebral oxygen saturation(rSO2)were measured at T0,T3 and T5.Serum neuron specific enolase(NSE)level was detected on the 3rd day after operation.National Institutes of Health Stroke Scale(NIHSS)was adopted to evaluate cognitive function.Results The operation was successfully completed in both groups without aneurysm rupture.MAP and HR at T1 in nitroglycerin group were significantly lower than those in sevoflurane group(P<0.05).MAP at T4 in nitroglycerin group was significantly higher than that at T3(P<0.05),which was also significantly higher than that in sevoflurane group(P<0.05).MAP at T4 in sevoflurane group was significantly higher than that at T3(P<0.05).The levels of CERO2 and rSO2 at T3 in both groups were significantly lower than those at T0(P<0.05),and increased significantly at T5(P<0.05).There w

关 键 词：颅内动脉瘤夹闭术 七氟醚 硝酸甘油 控制性降压 脑氧代谢 认知功能 

分 类 号：R651.1[医药卫生—外科学]