颅脑手术患者不同血压水平对内脏灌注和代谢指标的影响

目的：观察颅脑手术患者不同血压水平对内脏灌注、pH值、BE值、乳酸值及C-反应蛋白的影响。方法：择期行颅脑手术的患者45例,随机分为A、B、C三组,每组15例。A组和B组的MAP分别控制在50～55mmHg和60～65mmHg,C组（对照组）不行控制性降压。在围降压期采集动脉血,测定pH、BE、PaCO2、乳酸值、血清胱抑素C（ScysC）及超敏C-反应蛋白（hs-CRP）浓度,使用空气胃张力计测定胃黏膜pH值（i-pH）及PgCO2-PaCO2的差值（Pg-aCO2）。结果：三组pH、BE、i-pH、Pg-aCO2、hs-CRP、血乳酸浓度组间比较差异无显著性。A组的血清ScysC浓度在降至目标压60min和停止降压后30min时显著高于T0（P〈0.05或0.01）,并在停止降压后30min时显著高于B组和C组（P〈0.05）。结论：颅脑手术控制性降压程度以60～65mmHg为宜。

Influence of sodium nitroprusside-induced controlled hypotension in different degrees on splanchnic perfusion and metabolism in patients undergoing neurosurgicaloperation

Objective： To observe the influence of controlled hypotension （CH） induced by sodium nitroprusside in different degrees on splanchnic perfusion and metabolism in patients undergoing neurosurgical operation.Methods： Forty-five patients scheduled for elective neurosurgical operation were randomly divided into three groups （n =15 per each group）： In group A and group B,MAP was respectively kept between 50～55 mmHg and 60～65 mmHg,in group C （Control group） no hypotension was performed.Blood samples were taken during hypotension for blood gas analysis and determination of serum levels of lactic acid,ultrasensitive C-reactive protein （hs-CRP） and cystatin C （ScysC）.Gastric CO2 （PgCO2） and i-pH was measured with gastric tonometry.Results： In group A,ScysC concentrations were signifi-cantly higher than those in group B and C （P 0.05） at 60 min during hypotension.There were no significant differences in pH,BE,i-pH,Pg-aCO2,hs-CRP,lactic acid among the three groups.Conclusion： The margin of safety for controlled hypotension,a lower limit of 60 mmHg for MAP may be more adequate for patients undergoing neurosurgical operation.