静吸复合麻醉对脑动脉瘤夹闭术中收缩和舒张血管物质的影响

Effects of inhalational anesthesia combined with intravenous anesthesia on plasma vasoconstrictor and vasodilator during clipping of intracranial aneurysm

目的:观察静吸复合麻醉期间颅内动脉瘤病人行夹闭术中血管紧张素II(AT-Ⅱ)、内皮素(ET)和降钙素基因相关肽(CGRP)的变化。方法:颅内动脉瘤拟行择期开颅动脉瘤夹闭术病人20例,麻醉诱导后气管插管控制呼吸,异丙酚4mg/(kg·h),异氟醚(MAC1%～1.5%)维持麻醉。分别于麻醉诱导前(T0)、剪硬膜(T1)、夹闭动脉瘤(T2)和动脉瘤夹闭后30分钟(T3)4个时点采集动脉血,应用放免法检测血浆中AT-Ⅱ、ET和CGRP的浓度。结果:4个时点AT-Ⅱ均在正常值范围。ET于麻醉中3个时点明显低于T0(P<0.01)。麻醉中3个时点CGRP与T0比较呈显著性升高。结论:静吸复合麻醉下开颅动脉瘤夹闭术中缩血管物质降低,舒血管物质升高,提示静吸复合麻醉能有效预防术中急性脑血管痉挛,麻醉中应注重扩血管治疗。

Objective：To investisate the change in angiotensin-Ⅱ （AT-Ⅱ ）,endothelin （ET）and calcitonin gene-related peptide （CGRP） during clipping of intracranial aneurysm performed under inhalational anesthesia combined with intravenous anesthesia.Methods： Twenty Hunt and Hess I - Ⅱ ,ASA I - Ⅱ patients undegning elective clipping of intracranial aneurysm.Anesthesia was induced with midazolam 0.05 mg/kg, remifentanyl l ug/kg,propofol 2 mg/kg and vecuronium 0.1 mg/kg. The patients were mechanically ventilated after tracheal intubation and PETCO2 was maintained at 30-35 mmHg.Anesthesia was maintained with propefol 4 mg/kg,isoflurane at 1.0-1.5 MAC,remifentanil 0.1 p, ug/（kg, min）,vecuronium 1 p,g/（kg.min）.Radial artery was canndated for direct continuous BP monitoring.ECG, HR,SPO2 and PETCO2 were continuous monitored during operation.Blood samples were taken before induction of anesthesia（T0, baseline）, when dura was opened（T0 ,while aneurysm was being clipped（T2）and 30 min after clipping（T3） for determination of plasma concentrations of AT-Ⅱ,ET and CGRP.Results：Plasma concentration of AT-Ⅱ did not change significantly thoughout the surgery.Plasma ET concentration decreased significantly at T2 and T3 compared with the baseline （P〈0.01）.Plasma CGRP level increased signticantly during operation compared with the baseline （P〈0.01）.Conelusion：Cerebral vasoconstrictors increase,vasodilator decreases during inhalational anesthesia combined with intravenous anesthesia.It is suggested that inhalational anesthesia combined with intravenous anesthesia can prevent acute cerebral vasospasm and treatment with vasodilator should be considered during clipping of intracranial aneurysm.