尼卡地平与硝酸甘油控制性降压对颅内动脉瘤夹闭术患者脑氧代谢的影响

目的对比尼卡地平与硝酸甘油控制性降压对颅内动脉瘤夹闭术患者脑氧代谢的影响。方法采取随机、对照、双盲的方法将40例行颅内动脉瘤夹闭术的患者分成尼卡地平(Ⅰ)组和硝酸甘油(Ⅱ)组,每组20人。打开硬脑膜行控制性降压,并于打开硬脑膜即刻(T0)、瘤体分离结束(T1)、夹闭完毕(T2)、停止控制性降压20min(T3)四个时点行桡动脉及颈内静脉球血气分析,记录PaO2、PjvO2、SaO2、SjvO2、Hab、Hjvb值,并计算Da-jvO2、COER值。结果两组患者在控制性降压效果上无明显统计学差异(P>0.05),降压期间心率均增快(P<0.01);Ⅰ组患者在T1、T2时点SjvO2值较T0、T3时点明显升高(P<0.05或P<0.01),而Da-jvO2、COER值明显降低(P<0.01);Ⅱ组患者T1、T2时点SjvO2、Da-jvO2、COER值与T0、T3时点比较无明显统计学差异(P>0.05);Ⅰ组患者在T1、T2时点SjvO2值对应Ⅱ组明显升高(P<0.05),而Da-jvO2、COER值明显降低(P<0.05)。结论硝酸甘油与尼卡地平均可安全用于颅内动脉瘤夹闭术的控制性降压,但后者能有效降低脑氧代谢,改善脑氧合,脑保护作用更优越。

Effects of nicardipine and nitroglycerin on cerebral oxygen metabolism during controlled hypotension in intracranial aneurysm clipping surgery

Objective To compare the effects of controlled hypotension respectively with nicardipine and nitroglycerin on cerebral oxygen metabolism in intracranial aneurysm clipping surgery. Methods 40 patients,involved in this randomized,controlled and double-blind trail, undergoing intracranial aneurysm clipping surgery were devided into Nicardipine（ Ⅰ ） Group and Nitroglycerin（ Ⅱ ） Group with 20 cases each. Control hypotension at the moment of cutting duramater. Blood gas analyses were performed at the time of To ,T1 ,T2 and T3 ,respectively corresponding to the moment of cutting duramater,aneurysm isolation completed, aneurysm clipping done and 20 min after controlled hypotension, by taking samples from radical arteries and jugular vein bulbs. Record the values of PaO2 , PjvO2 , SaO2 , SjvO2 , Hab, Hjvb and calculate the values of Da-jvO2 and COER. Rsecults Blood pressures were kept at a desirable level without signifi- cant difference （P〉0.05）. Heart rates in both groups increased obviously （P〈0.01）without intergroup difference（P 〈0.05） during controlled hypotension. Compared with To and Ta, the values of SjvO2 at T1 and T2 increased significantly（P%0.05 or〈0.01） whereas the values of Da-jvO2 and COER decreased significantly （P〈0.01） in group Ⅰ. The values of SjvO2,Da-jvO2 and COER at T1 and T2 were no significant difference with its values at T0 and T3 in group Ⅱ （P〉0.05）. Compared with group Ⅱ ,the values of SivO2 at T2 and T3 were significantly higher （P〈0.05） whereas the values of Da-jvO2 and COER were significantly lower （P〈0.05） in group Ⅰ . Conclusion Both nitroglycerin and nicardipine can be safely used for controlling hypotension in intracranial aneurysm clipping surgery. But the later can effectively decrease cerebral oxygen metabolism and improve cerebral oxygenation which is superior to the former in terms of cerebral protection.