小剂量去甲肾上腺素联合目标导向液体治疗对脑血运重建术患者围手术期的脑保护作用  

Perioperative cerebral protective effects of small dose norepinephrine combined with goal-directed fluid therapy in patients with cerebral revascularization

作　　者：雷田田 孟利江 张山[1] LEI Tiantian;MENG Lijiang;ZHANG Shan(Department of Anesthesiology,Second Hospital of Hebei Medical University,Shijiazhuang,Hebei 050000,China)

机构地区：[1]河北医科大学第二医院麻醉科,石家庄050000

出　　处：《重庆医学》2024年第12期1850-1855,共6页Chongqing medicine

摘　　要：目的探讨小剂量去甲肾上腺素(NE)联合目标导向液体治疗(GDFT)对脑血运重建术患者围手术期的脑保护作用。方法选取2019年12月至2020年12月该院择期行颞浅动脉-大脑中动脉搭桥术患者40例为研究对象,采用随机数字表法分为小剂量NE联合GDFT组(G组)和小剂量NE联合常规液体治疗组(C组),每组20例。G组以每搏量变异度(SVV)为目标导向进行补液,C组依据传统输液方案进行容量治疗,两组均在麻醉诱导后持续泵注小剂量NE 0.01~0.03μg·kg^(-1)·min^(-1)。记录患者麻醉诱导后(T_(1))、大脑中动脉阻断即刻(T_(2))、血管搭桥灌通即刻(T_(3))、术毕(T_(4))时点血流动力学、脑氧代谢相关指标,测定神经损伤标志物S100β蛋白、神经元特异性烯醇化酶(NSE)水平。记录两组患者术中出入量、术后并发症发生情况、术后住院时间,以及术前(D_(0))、术后1 d(D_(1))、术后3 d(D_(3))、术后7 d(D_(7))4个时点的美国国立卫生研究院卒中量表(NIHSS)评分。结果两组大脑中动脉阻断时间、术中出量、术后住院时间、并发症发生率,各时点心率(HR)、动静脉血氧含量差(Da-jvO_(2))、脑乳酸生成率(LacPR)比较差异均无统计学意义(P>0.05)。与C组比较,G组晶体液入量、胶体液入量、总入量明显减少,平均动脉压(MAP)、颈内静脉球部血氧饱和度(SjvO_(2))在T_(4)时点明显升高,脑氧摄取率(CERO_(2))、S100β蛋白、NSE在T_(4)时点明显降低,NIHSS评分在D 7明显降低,差异均有统计学意义(P<0.05)。结论行脑血运重建术患者在接受GDFT的同时持续泵注小剂量NE,可减少术中输液总量,稳定血流动力学,优化大脑氧供,保护大脑功能。Objective To investigate the perioperative cerebral protective effects of small dose norepinephrine(NE)combined with goal-directed fluid therapy(GDFT)in the patients with cerebral revascularization.Methods Forty patients with scheduled superficial temporal artery-middle cerebral artery bypass grafting were selected as the study subjects and divided into the small dose NE combined GDFT group(group G)and small dose NE combined conventional fluid therapy group(group C),20 cases in each group.The group G conducted the fluid infusion with the stroke volume variation(SVV)as the goal orientation.The group C received the volumetric therapy by the traditional infusion regimen.The low-dose of norepinephrine(0.01-0.03μg·kg^(-1)·min^(-1))was continuously pumped after induction of anesthesia in both groups.The hemodynamic indexes and cerebral oxygen metabolism related indexes were recorded after anesthetic induction(T_(1)),immediately after middle cerebral artery occlusion(T_(2)),immediately after vascular bypass perfusion(T_(3))and at the end of operation(T_(4)),meanwhile,the levels of NSE and S100βwas measured.The intraoperastive intake and output amounts,postoperative complications,hospitalization duration and NIHSS scores at D_(0),D_(1),D_(3) and D_(7) were recorded.Results There were no statistically significant differences in the blocking time of middle cerebral artery,intraoperative output volume,hospitalization duration,complications occurrence rate,HR at each time point,Da-jvO_(2) and LacPR between the two groups(P>0.05).Compared with the group C,the crystal fluid intake volume,colloid fluid intake volume and total infusion volume in the group G were significantly decreased,MAP and SjvO_(2) at T_(4) were increased significantly,CERO_(2) at T_(4) was significantly decreased,the levels of S100βprotein and NSE at T_(4) were significantly decreased,the NIHSS score at D_(7) was significantly decreased,and the differences were statistically significant(P<0.05).Conclusion Simultaneous persistent pump injection of small

关 键 词：目标导向液体治疗 去甲肾上腺素 脑血运重建术 脑代谢 血流动力学指标 

分 类 号：R459.9[医药卫生—治疗学]