三脑室底造瘘术中的心率变化

目的 了解神经内镜下三脑室底造瘘术过程中心率变化情况.方法 分析35例三脑室底造瘘术患者的病历资料,根据麻醉记录单计算三脑室底造瘘术中每5min心率变化情况,计算其斜率和心率变化幅度,对照手术录像观察心率变化与手术操作间的关系.结果 35例患者中,11例患者术中出现快速的心率变化,斜率绝对值大于0.79,其中4例发生心动过速,2例发生心动过缓,6例快速心率变化发生于手术造瘘时,其中4例患者发生快速心率下降前没有明显心率上升改变;另5例发生于脑室冲洗止血过程中,所有患者中除1例心动过缓需要阿托品纠正,其余患者操作结束后自行缓解.结论 ETV术中快速心率变化比较常见,与快速冲洗脑室所致的颅内压升高和造瘘时三脑室底机械刺激有关,术中结合麻醉监测有助于提醒手术医师进行合理的手术操作,避免严重心律失常的发生.

The heart rate change during endoscopic third ventriculostomy

Objective To analysis the heart rate wave during endoscopic third ventriculostomy (ETV).Method We reviewed the data of 35 consecutive non-commutication hydrocephalus cases who received ETV in Bejing Tiantan hospital during Jan to Aug 2006.The heart rate(Hr)was written down on the anesthetic records every 5 minutes,so its change could be mathematically gotten.We chose slope rate as a mark of changing velocity and the change volume was also calculated.If there was an abrupt change of Hr,the patient's surgery video was showed to disclose what was done at that time.Results Abrupt changing of Hr was found in 11 cases with at least one time of slope rate higher or lower than±0.79,among which 2 patients had bradycardia and 4 had taehycardia.5 quick Hr changes were during irrigation and 6 during ventriculostomy.All patient's Hr came to stable after the surgery manipulate stopped or performed excerpt one case of bradycardia who needed an atropine.Conclusions During ETV,abrupt change of Hr is a common phenoment that closely associated with the mechanical stimulation to hypothalamus by ventriculostomy and the elevated intracranial pressure due to high speed irrigation.This kind of complications may be avoided through adopted surgery manipulation if co-worked with anesthesia.