神经外科术中硝普钠控制性降压期间血流动力学的变化

为观察神经外科术中硝普钠控制性降压 (CH)对血流动力学的影响 ,对 1 5例ASAⅠ～Ⅱ级无心肺疾患的择期颅脑手术病人 (男 5例 ,女 1 0例 ,年龄 1 9～ 5 5岁 ) ,术中吸入 1 .0MAC异氟醚维持麻醉。剪开硬膜后 ,需行控制性降压时 ,用微量泵输注硝普钠 ,初始量 1 .5～ 2 μg/ (kg·min) ,将平均动脉压 (MAP)降至并维持在 7.3～ 8.0kPa(5 5～ 60mmHg)。连续监测无创平均动脉压 (MAP)、心率 (HR)、心电图 (ECG)、脉搏血氧饱和度 (SpO2 )。用HEMOSONICTM1 0 0经食管连续监测血流峰速度 (PV)、血流加速度 (ACC)、左室射血时间 (LVET)、每搏量 (SV)、心输出量 (CO) ,计算全身血管阻力 (TSVR)。用气体浓度监测仪 (DatexUltima,芬兰 )连续监测呼气末二氧化碳 (PetCO2 )、SpO2 、呼气末异氟醚浓度。分别于降压前、降压达目标时、维持降压 5、1 5和 3 0min、停降压 5、1 0min ,采集血流动力学参数进行统计学处理。在控制性降压期间ACC、PV、CO、SV和HR较降压前增加 2 0 .8%～ 41 .1 %、1 8.1 %～ 2 6.3 %、2 1 .6%～ 2 7.9%、2 .7%～ 7.6%和 2 0 .5 %～ 2 5 .0 % ;TSVR下降 3 5 .1 %～ 3 9.1 %。结果提示 :神经外科术中行硝普钠控制性降压具有起效快 ,作用强 ,心输出量增加 ,复压迅速等优点

Hemodynamic Changes during Controlled Hypotension Induced by Sodium Nitroprusside in Neurosurgical Patients

To observe the hemodynamic changes during controlled hypotension (CH) induced by sodium nitroprusside (SNP) in neurosurgical patients, fifteen ASA Ⅰ～Ⅱ patients (5 male, 10 female), aged 19～55 years, undergoing elective neurosurgery were enrolled in this study. Anesthesia was maintained with 1.0 MAC isoflurane. Controlled hypotension was performed after opening dura and the MAP was reduced and maintained to 7.3～8.0 kPa (55～60 mmHg) with continuous infusion of SNP at 1.5～2 μg/(kg·min) by micro pump (Grasby, England). MAP, HR, ECG, SpO₂ were monitored. HEMOSONIC^TM 100 Monitor was used to measure PV, Acc, LVET, SV, CO and TSVR. PetCO₂, MAC was continuously measured by gas monitor (Datex, Ultima, Fenland). Hymodynamic parameters were recorded before hypotension, 5 min, 15 min and 30 min during hypotension, and 5 min and 10 min after discontinuing hypotension. During controlled hypotension, ACC、PV、CO、SV and HR increased by 20.8%～41.1%, 18.1%～26.3%, 21.6%～27.9%, 2.7%～7.6% and 20.5%～ 25.0%, respectively, compared with those before hypotension. TSVR decreased by 35.1～39.1%. Controlled hypotension with SNP for neurosurgical patients possess several advantages such as fast onset of action, decreased peripheral resistance, increased cardiac function and easy recovery of blood pressure.