尼莫地平控制性降压对颅内动脉瘤夹闭术中脑氧代谢的影响

目的观察颅内动脉瘤夹闭术中应用尼莫地平控制性降压对脑氧代谢的影响。方法选择颅内动脉瘤夹闭术患者30例,根据控制降压药随机分为2组:硝酸甘油组(A组,n=15)和尼莫地平组(B组,n=15),于不同时间段行动静脉血气分析和血乳酸含量测定。结果(1)A组的心率在降压中的两时间点明显快于降压前,差异有统计学意义(P<0.05),在降压30min和夹闭后两时间点上,B组的HR明显较A组慢,差异有统计学意义(P<0.05)。(2)B组的D(a-jv)O2和D(jv-a)BG在降压30min、夹闭后及停降压30min时3个时间点明显少于A组,差异有统计学意义(P<0.01);与降压前比较,B组的D(a-jv)O2和D(jv-a)BG在降压30min和夹闭后两时间点明显下降,差异有统计学意义(P<0.01)。结论尼莫地平可安全用于动脉瘤夹闭术中控制性降压,降低脑氧代谢和改善脑氧合,有较好的脑保护作用。

Effect of nimodipine controlled blood pressure lowering on cerebral oxygenation and metabolism during intracranial aneury surgery

Objective To evaluate the effect of nimodipine controlled blood pressure lowering on cerebral oxygenation and metabolism during intracranial aneurysm surgery. Methods Thirty patients [Society of Anesthiologist (ASA) Ⅰ-Ⅱ] scheduled for elective intracranial aneurysm surgery were divided into two groups:nitroglycerin group (group A, n=15) and nimodipine group (group B, n=15). Arterial and jugular bulb venous blood samples were taken before,during and after induced blood pressure lowering for determination of oxygen content, oxygen saturation and glucose levels.The cerebral arterio-venous differences in oxygen content [D(a-jv)O2],cerebral oxygen extraction rate (CERO2) in glucose concentration [D(jv -a)BG] were calculated. Results Heart rate (HR) of group A significantly increased during the period of blood pressure lowering,HR of group B were kept stable, HR was significantly lower in group B than in group A. D(a-jv)O2 and D(jv-a)BG of group B significantly decreased during the period of blood pressure lowering compared to baseline values, D(a-jv)O2 and D(jv-a)BG were significantly lower in group B than in group A during and after the period of blood pressure lowering. Conclusions Nimodipine induced blood pressure lowering during intracranial aneurysm surgery is safe, can decrease cerebral metabolism, improve oxygenation and plays a role in cerebral protection.