摘要
目的比较瑞芬太尼与硝酸甘油控制性降压,对急性高容量血液稀释(AHH)后颅内动脉瘤夹闭术病人脑氧代谢的影响。方法颅内动脉瘤夹闭术病人30例随机等分为硝酸甘油组和瑞芬太尼组。手术开始时以15～20 ml/(kg.h)的速率输入4%琥珀酰明胶,使红细胞比容稀释为25%～32%。剪开硬脑膜后,分别泵入硝酸甘油和瑞芬太尼控制性降压,使平均动脉压(MAP)维持在60～65 mmHg。分别于降压前(T1)、降压后30 min(T2)、动脉瘤夹闭后5 min(T3)抽取颈内静脉球部血和桡动脉血作血气分析,比较两组对脑氧代谢的影响。结果血流动力学变化:与同组内T1比较,两组T2、T3的MAP和心率差异均有统计学意义(P<0.01);两组同时间点MAP比较差异无统计学意义(P>0.05),心率差异有统计学意义(P<0.01)。脑氧代谢的变化:与同组内T1比较,瑞芬太尼组T2、T3的静脉血氧饱和度(SjvO2)和颈内静脉氧含量(CjvO2)明显升高,动脉-颈内静脉球部血氧差[D(a-jv)O2]和氧摄取率(ERO2)明显降低(P<0.01);两组同时间点(T2、T3)比较,SjvO2、CjvO2、D(a-jv)O2、ERO2差异均有统计学意义(P<0.01)。结论瑞芬太尼控制性降压用于AHH后的颅内动脉瘤夹闭术病人,可降低脑氧代谢率,增强脑组织对缺氧的耐受性,比硝酸甘油控制性降压更具优越性。
Objective To compare the effects of remifentanil-and nitroglycerin-induced controlled hypotension（CH） on cerebral oxygen metabolism in patients with intracranial aneurysm clipping after acute hypervolemic hemodilution（AHH）.Methods Thirty patients with intracranial aneurysm occlusion were randomly and equally divided into nitroglycerin group and remifentanil group.Both groups were given 4% succinylated gelatin at the speed of 15-20 ml/（kg.h） at the beginning of the surgery to dilute the blood to a hematocrit of 25%-32%.CH was performed after cutting the dura mater with nitroglycerin and remifentanil being pumped respectively,to make the mean arterial pressure（MAP） maintain at 60-65 mmHg.The blood was collected from the jugular vein bulb and radial artery for blood gas analysis to compare the effect of cerebral oxygen metabolism between two groups at the following three time points,before CH（T1）,thirty minutes after CH（T2） and five minutes after aneurysm clipping（T3）.Results The changes of hemodynamics： compared with T1 in the same group,significant differences were found in MAP and heart rate（HR） at points T2 and T3 between the two groups（P 0.01）.At the same time point,no significant difference was found in MAP between the two groups（P 0.05）,but significant difference in HR（P 0.01）.The changes of cerebral oxygen metabolism： compared with T1 in the same group,SjvO2 and CjvO2 significantly increased,and D（a-jv）O2 and ERO2 significantly decreased at the time points T2 and T3 in remifentanil group（P 0.01）.At the same time points（T2,T3）,significant differences were found in SjvO2,CjvO2,D（a-jv）O2and ERO2between the two groups（P 0.01）.Conclusions Remifentanil-induced CH can reduce the cerebral oxygen metabolism rate,enhance the brain tolerance to hypoxia,and has more advantages than nitroglycerin-induced CH in patients with intracranial aneurysm clipping after AHH.
出处
《中国微侵袭神经外科杂志》
CAS
2012年第3期100-103,共4页
Chinese Journal of Minimally Invasive Neurosurgery
基金
江西省卫生厅科技计划项目(编号:20081046)
关键词
颅内动脉瘤
降压
控制性
氧代谢
脑
瑞芬太尼
硝酸甘油
intracranial aneurysm
hypotension
controlled
oxygen metabolism
brain
remifentanil
nitroglycerin
