术前液体治疗对成人烟雾病患者麻醉诱导后血压波动的效果分析  

Effect of preoperative fluid therapy on the blood pressure varibility after anesthesia induction in adult patients with Moyamoya disease

作　　者：赵东红[1] 李晶[1] Zhao Donghong;Li Jing(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100070

出　　处：《中国脑血管病杂志》2022年第4期264-270,277,共8页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的 探讨术前液体治疗对成人烟雾病患者麻醉诱导后血压波动的效果。方法 前瞻性连续纳入2020年1月1日至2021年6月30日在首都医科大学附属北京天坛医院神经外科行颅内外血运重建术的烟雾病患者,纳入患者的年龄为18~60岁,体质量为50~80 kg,术前头部CT灌注成像显示患侧有明确的低灌注表现,且均为上午第一台手术。根据随机数字表法按1∶1比例,将纳入患者分配到观察组及对照组。观察组和对照组患者于前一晚24∶00后禁食水,观察组在此基础上于术日5∶00,在150 min内静脉补液1 000 ml(羟乙基淀粉500 ml+0.9%氯化钠注射液500 ml)。分别于术前、麻醉诱导后应用血管活性药物前记录两组患者的收缩压,以此评价对血压波动的影响。比较两组患者性别、年龄、手术侧别(左、右)、发病类型[脑出血、脑梗死、短暂性脑缺血发作、其他(心肌梗死、癫痫发作)]、术前铃木分期、既往史(高血压病、糖尿病、高脂血症、冠心病)、手术类型的差异,以及术后脑梗死、过度灌注、脑出血、头皮感染等并发症的发生情况。结果 共有569例烟雾病患者在首都医科大学附属北京天坛医院神经外科行不同类型的颅内外血运重建术,排除难以控制的高血压病16例、烟雾综合征21例、患者拒绝入组54例,最终纳入478例进行研究,对照组与观察组各239例。观察组与对照组患者性别、年龄、手术侧别、发病类型、术前铃木分期、既往史、手术类型的差异均无统计学意义(均P>0.05)。观察组与对照组术前平均收缩压的差异无统计学意义(P>0.05),麻醉诱导后使用血管活性药物之前观察组平均收缩压高于对照组,组间差异有统计学意义[(127±11) mmHg比(112±10) mmHg,t=2.932,P=0.003];观察组麻醉诱导后使用血管活性药物之前与术前收缩压的差值低于对照组,组间差异有统计学意义[(11±5) mmHg比(23±8) mmHg,t=2.895,P=0.003]�Objective To investigate the effect of preoperative fluid therapy on the blood pressure varibility after anesthesia induction in adult patients with Moyamoya disease. Methods From January 1, 2020 to June 30, 2021, patients with Moyamoya disease who underwent extracranial to intracranial revascularization in the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University were prospectively enrolled. The age of the patients was 18-60 years old and body weight was 50-80 kg. Preoperative CT perfusion imaging showed that the affected side had a clear manifestation of low perfusion, and all of them were operated on for the first time in the morning. According to the random number table method and the proportion of 1∶1, the included patients were assigned to the observation group and the control group. Patients in the observation group and the control group fasted after 24∶00 the night before. On this basis, the observation group was given an intravenous infusion of 1 000 ml(hydroxyethyl starch 500 ml + 0.9% sodium chloride injection 500 ml) at 5∶00 on the day of operation. The systolic blood pressure of the two groups was recorded before operation and before the administration of vasoactive drugs after anesthesia induction, and the effect on blood pressure fluctuation was evaluated. The gender, age, surgical side(left, right), disease type(cerebral hemorrhage, cerebral infarction, transient ischemic attack, others [myocardial infarction, epilepsy]), Suzuki stage before the operation, past medical history(hypertension, diabetes, hyperlipidemia, coronary heart disease), and the type of operation were compared between the two groups. The occurrence of postoperative cerebral infarction, hyper-perfusion, cerebral hemorrhage, scalp infection, and other complications was also compared between the two groups. Results During the study, a total of 569 patients with Moyamoya disease underwent different types of extracranial to intracranial revascularization in the Department of Neurosurge

关 键 词：烟雾病 液体治疗 脑梗死 过度灌注 

分 类 号：R614[医药卫生—麻醉学]