颅底外科麻醉控制性降压对脑代谢和颅内压的影响

The effect of deliberate hypotension on cerebral metabolism and incranial pressure during skull base surgery

目的:观察颅底外科麻醉控制性降压对脑代谢、脑内压的影响。方法。颅底手术病人20例,异氟醚吸入全麻,静滴0.01％硝普钠行控制性降压,维持平均动脉压(MAP)8.0±0.7kPa。连续监测血压,经颈内静脉逆行置管同步采集动脉血和颈内静脉血作血气分析,计动-静脉氧含量差(Da-vO_2)、脑氧摄取率(ERO_2);测动、静脉血乳酸含量(CaL、CvL)及两者之差(Da-vL)。经蛛网膜下腔置管连续监测颅内压(ICP)。结果:术中降压稳定,ICP无明显波动。Da-vO_2、ERO_2与Da-vL均无明显改变。结论:颅底手术行异氟醚吸入、硝普钠静滴控制性降压可保持脑氧供需平衡稳定,不影响颅内压。

Objective:To evaluate the influence of nitroprusside sodium-induced hypotension on cerebral metabolism and incranial pressure during skull base surgery. Method:Hypotension induced by nitroprusside sodium (SNP)was used in 20 patients during isoflurane anesthesia for skull base surgery.MAP was maintained at 8.0±0.7 kPa.Intracranial pressure(ICP)was measured continuously through subarachnoid catheterization. Arterial and venous blood samples were drainaged simultaneously through radial artery and internal jugular catheterization. The cerebral arteriovenous differences of oxygen content(Da-vO_2)and lactate content(Da-vL)were measured and extracting rate of oxygen(ERO_2)was calculated.Result:After infusion of SNP,ICP did not changed and CPP was decreased significantly by falling of MAP,but Da-vO_2,Da-vL and ERO_2 were not affected. Conclusion:Long-term deliberate hypotension with SNP had no adverse effect on cerebral oxygen balance,lactate metabolism and ICP.