深低温停循环下颅内巨大基底动脉瘤手术的麻醉处理

Anesthetic management for clipping giant intracranial basilar artery aneurysm under deep hypothermic circulatory arrest

目的探讨颅内基底动脉瘤手术中深低温停循环技术(DHCA)的应用和围术期的麻醉管理。方法根据7例深低温停循环下颅内巨大基底动脉瘤手术中脑氧饱和度(rSO2)以及体温、心电图等监测指标的变化,调控围术期的管理措施,以期维护术中脑等重要生命器官的氧供需平衡;并观察、记录术后患者的转归和并发症发生情况。结果即使在深低温的条件下,停循环也可使rSO2明显降低,恢复循环后可逐渐得以改善。低流量灌注与停循环相比较,前者可使脑氧供需平衡得以更好的维持。本组7例患者术后未出现停循环所致全脑缺氧的情况,尽管有3例患者死亡。结论DH-CA辅以相应的脑保护措施和监测手段可有效的应用于颅内巨大基底动脉瘤的手术,而在避免全脑缺氧的同时,降低局部血管损伤的发生率也是改善手术预后的重要一环。

Objective To study the performance of deep hypothermic circulatory arrest and the anesthestic management for giant intracranial basilar artery aneurysm. Methods Seven patients undergoing resection of giant intracranial basilar artery aneurysm were included in the study. By monitoring cerebral oximetry (rSO_2), body temperature and electrocardiogram (ECG), brain and other vital organs were guaranteed to maintain oxygen supply/demand balance in perioperative management, especially during the circulatory arrest period under deep hypothermia. The measured parameters, the outcome of patients and the complications were observed and recorded. Results Even in profound hypothermic condition, rSO_2 was degraded significantly during circulatory arrest, and recovered after in circuit. Low flow perfusion maintained cerebral oxygen supply/demand balance better than circulatory arrest. In all 7 cases, cerebral anoxia caused by circulation arrest after operation were not observed. Conclusion Deep hypothermic circulation arrest could be applied effectively in the resection of giant intracranial basilar artery aneurysm with brain protective measure and monitoring. To improve the outcomes of the patients, avoiding cerebral anoxia and of local vessel injuries is important.