尼莫地平对颅内动脉瘤夹闭术围术期脑脊液S100B含量的影响

Effects of Intraoperative Continuous Nimodipine Infusion on Systemic Hemodynamics and S100B Protein in Cerebrospinal Fluid during Aneurysm Surgery

目的 :探讨尼莫地平在颅内动脉瘤夹闭术中的安全性及其对脑功能的影响。方法 :将颅内动脉瘤夹闭术患者随机分为ISO组和NIMO组 ,每组15例。2组术中均吸入1 2 %异氟醚维持麻醉。NIMO组同时在诱导后开始持续输注尼莫地平20μg/(kg·h)直至手术结束。分别于不同时间测定循环指标 ,动脉瘤夹闭后2h、4h测定脑脊液S100B蛋白含量。结果 :(1)同ISO组相比 ,NIMO组术中血压下降均在临床安全范围内 ,而心率无显著性变化。 (2)NIMO组在动脉瘤夹闭前后脑脊液中S100B浓度无明显变化 ,而ISO组在动脉瘤夹闭后4h脑脊液中S100B浓度明显升高(F=4.108,P<0.05)。2组间同一时间点脑脊液中S100B蛋白浓度均无明显差异。结论 :尼莫地平对全身血流动力学影响小 ,该剂量可减轻动脉瘤夹闭后载瘤动脉血管痉挛的程度。

Objective:To evaluate the effects of intraoperative continuous nimodipine infusion on systemic hemodynamics and S100B protein in cerebrospinal fluid during aneurysm surgery.Methods:Thirty consecuˉtive patients who underwent intracranial aneurysm surgery without a preexisting cerebral ischemia were prospectively randomized into two groups which included isoflurane maintained anesthesia(group A,n=15)and nimodipine infusion(group B,n=15).The patients in group A were given nimodipine infusion continuˉously [20μg/(kg·h)] after induction of anesthesia and anesthetized with1.2%isoflurane.The patients in group B were maintained with1MAC isoflurane anesthesia during the whole procedure.Systemic hemodynamics was monitored intraoperatively.S100B levels in cerebrospinal fluid were observed before aneurysm clipping and0,2,4h after aneurysm clipped.Neurological complications were assessed at the seventh day after operaˉtion.Results:Mean arterial pressure(MAP)was significantly lower in group B than that in group A,but MAP were kept in clinical safe range.Heart rate was kept stably.However,cardiac output,cardiac index,and myocardial contract acceleration were increased significantly in group B,and systemic vascular resistance deˉcreased after nimodipine infused.S100B in CSF was increased significantly at4h after aneurysm clipped in group A,and S100B in cerebrospinal fluid was stable in group B.Conclusion:Systemic hemodynamics during intraoperative continuous nimodipine [20μg/(kg·h)]infusion combined with1MAC isoflurane anesthesia are in clinical safe range.Intraoperative nimodipine may pose cerebral protection for intracranial aneurysm surgery.