神经外科手术中控制性降压对内脏灌注的影响  

The Influence of Deliberate Hypotension on Splanchnic Mucosal Perfusion Using Gastric Tonometry in Patients Undergoing Craniotomy

作　　者：李一亮[1] 顾敏杰[1] 薛庆生[1] 于布为[1] 

机构地区：[1]上海第二医科大学瑞金医院麻醉科,上海200025

出　　处：《上海第二医科大学学报》2003年第5期449-451,共3页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的 利用空气胃张力计观察神经外科手术中控制性降压对内脏灌注的影响。方法 10例择期行颅脑手术的病人,在手术需要降压(打开颅骨)时开始行控制性降压,3h后停止。记录基础值、降压后1、2、3h及停止降压后1h的pHi,pHa,PetCO_2-PiCO_2差值。结果 行控制性降压后,血压下降明显。pHi较基础值有所下降,但无统计学意义,所有病人的pHi均大于7.38。pHa均在正常范围内。结论 控制性降压对内脏灌注有轻微的影响,但不会引起内脏的缺血缺氧。Objective To evaluate the influence of deliberate hypotension induced by isoflurane and propofol on splanchnic mucosal perfusion using gastric tonometry. Methods In ten patients (4 females, 6 males) undergoing elective craniotomy, deliberate hypotension was initiated after craniotomy and terminated three hours later. The arterial blood pressure ( MAP) was maintained 25%-30% below the initial parameters during deliberate hypotension. Measurements included gastric pH (pHi) , arterial blood pH ( pHa) , diference between PetCO2 and piCO2. These parameters were measured before the inducting of deliberate hypotension, after 1h, 2h and 3h and 1h after recovery from hypotension. Results DH was satisfactorily established. Intramucosal pH values decreased slightly after 1 , 2 and 3h of deliberate hypotension but none of the pHi was less than 7.38. Conclusion Deliberate hypotension slightly impairs splanchnic perfusion but does not lead to ischemia and hypoxia in tissues.

关 键 词：神经外科手术 控制性降压 内脏灌注 空气胃张力技术 胃粘膜PH值 

分 类 号：R614[医药卫生—麻醉学]