控制性降压对颅内动脉瘤手术病人局部脑血流的影响

为观察控制性降压对颅内动脉瘤夹闭术术中局部脑血流 (rCBF)的影响 ,将 2 0例病人用数字表法随机分为异氟醚组 (A组 ,n =1 0 )和尼莫地平组 (B组 ,n =1 0 )。A组用异氟醚吸入降压 ;B组用尼莫地平静脉注射 ,继以持续泵入降压 ,2组均维持平均动脉压 (MAP)在 8.0～ 8.7kPa(60～ 65mmHg)。动脉瘤夹闭后 ,2组均停止降压 ,并用罂粟碱浸泡术野 ;用激光多普勒血流仪监测局部rCBF的变化。结果 :2组在降压前后rCBF均无明显变化 (P >0 .0 5 ) ;与动脉瘤夹闭前相比 ,夹闭后A组rCBF明显减少 (P <0 .0 5 ) ,B组rCBF变化不大 (P >0 .0 5 ) ;应用罂粟碱后 ,2组rCBF均明显升高 (P <0 .0 5 ) ,其中A组增加的幅度明显大于B组 (P <0 .0 5 )。结果提示 :在颅内动脉瘤夹闭术术中 ,用尼莫地平控制性降压 ,rCBF的变化比较平稳。

Effects of Controlled Hypotension on Regional Cerebral Blood Flow in Intracranial Aneurysm Surgery

The aim was to observe the effects of controlled hypotension on regional cerebral blood flow (rCBF) in intracranial aneurysm surgery. Twenty patients were randomly divided into isoflurane (A, n=10) and nimodipine (B, n=10) groups. During controlled hypotension, mean artery pressure(MAP) was maintained at 8.0～8.7(60～65 mmHg) kPa in both groups. In group A, Isoflurane inhalation concentration was increased to 1.4～1.6 MAC. In group B, a bolus of nimodipine was given, followed by a continuous infusion of 10～100 μg/(kg·h). After aneurysm was clipped, papaverine was applied to all major vessels for 10 min. RCBF was continuously measured by laser Doppler flowmeter during the procedure. After clipping aneurysm rCBF decreased significantly in group A compared with before clipping aneurysm(P<0.05). There was no significant change in group B(P>05). After local application of papaverine, rCBF significantly increased in both groups(P<0.05), but the degree of increasing in group A was higher than that in group B(P<0.05). When intraoperative hypotension is induced by nimodipine rCBF is steadier than it is induced by isoflurane.