硝普钠控制性降压对血液动力学及脑氧平衡的影响

目的 研究硝普钠控制性降压对颅内手术病人血液动力学及脑氧供需平衡的影响。方法 择期颅内手术病人12例,用硝普钠使平均动脉压(MAP)降至50～65mmHg,并维持30min。降压前后,自桡动脉和颈内静脉球部取血进行血气分析和血糖测定,并以CO2复吸人法无创心排血量监舅仪(NiCO2)连续监测心排血量(CO)。结果 (1)降压期间,HR明显加快,CO先下降后又回升至降压前水平;颈静脉血氧饱和度无明显下降;(2)动-颈内静脉球部氧含量差、脑氧摄取率、动-颈内静脉糖含量差和脑葡萄糖摄率麻醉后均显著下降,降压及停降压后均进一步下降,仅脑氧摄取率降压后稍增加。结论 硝普钠控制性降压时心率增快,CO无明显变化,脑氧供需可维持平衡,但对葡萄糖的利用减少。

Effects of induced hypotension with nitroprusside on hymodynamics and balance between cerebral oxygen delivery and consumption

Objective To study the effects of induced hypotension with nitroprusside on hymodynamics and balance between cerebral oxygen delivery and consumption in intracranial surgical patients.Methods Sodium nitroprusside was intravenously infused to reduce mean artery pressure (MAP)to 50 65mmHg for 30 minutes in 12 elective intracranial surgical patients.The blood samples were drawn from radial artery and jugular bulb venous for blood gas analysis,blood glucose measurements,and NICO 2 continuous noinvasive cardiac output monitoring before,during and after induced hypotension.Results (1)Heart rate significantly increased,CO slightly decreased firstly and then returned to the level of before induced hypotension,and jugular bulb venous oxygen saturation(SjvO 2)had no significant decreases during induced hypotension.(2)Oxygen and glucose content different of artery and jugular bulb venous and cerebral oxygen and glucose extraction ratio markedly decreased after anesthesia,and further decreased during and after induced hypotension,but cerebral oxygen extraction ratio slightly increased during induced hypotension.Conclusion Induced hypotension with sodium nitroprusside can maintain the balance of cerebral oxygen delivery and consumption and the stability of CO with an increasetin HR and a decrease in glucose utilizing.