前列腺素E1脂微球载体制剂对颅内动脉瘤栓塞治疗患者麻醉复苏及预后的影响

Effects of lipo-prostaglandin E1 on anesthesis resuscitation and prognosis in patients with intracranial aneurysm during embolization therapy

目的评价颅内动脉瘤栓塞治疗患者麻醉前静脉注射前列腺素E1脂微球载体制剂(Lipo-PGE1)的临床价值。方法37例施行颅内动脉瘤栓塞治疗患者均符合Hunt-Hess分级0～Ⅱ级及美国麻醉医师协会分级Ⅰ～Ⅱ级,随机分为两组:Lipo-PGE1治疗组(18例)和对照组(19例);治疗组患者手术前1h静脉注射前列腺素E1脂微球载体制剂0.20μg/kg。采用静脉注射咪哒唑仑2.00mg/kg、芬太尼3.30μg/kg、维库溴铵0.13mg/kg和依托咪酯0.30mg/kg行诱导麻醉;雷米芬太尼0.20μg/(kg·min)和丙泊酚0.07mg/(kg·min)静脉滴注及复合静脉注射罗库溴铵30.00μg/(kg·min)维持麻醉。分别监测手术前后平均动脉压、心率、呼吸频率和脉搏氧饱和度;测定手术前和手术后24h血浆S-100蛋白含量;记录手术中脑血管痉挛发生率以及手术后麻醉复苏时间和恶心、寒战等不良反应发生率;评价运动神经功能。结果两组患者手术前后各项生命体征比较,差异无统计学意义(均P>0.05)。手术中治疗组患者发生脑血管痉挛2例(11.11%),明显低于对照组(9例,47.37%),差异有统计学意义(P<0.05)。手术后治疗组患者血浆S-100蛋白含量和麻醉复苏时间分别为(0.36±0.08)μg/L和(13.52±1.93)min,低于对照组的(0.89±0.14)μg/L和(16.41±3.72)min(均P<0.01)。与手术前相比,手术后对照组患者血浆S-100蛋白含量显著增加,组内比较差异有统计学意义(P<0.01);而治疗组则无明显变化(P>0.05)。根据GOS预后分级,治疗组患者运动神经功能评分优于对照组(P<0.05)。结论手术前尽早应用具有靶向扩张血管作用的前列腺素E1脂微球载体制剂,可拮抗继发性脑血管痉挛,促进手术后患者早期复苏,改善预后。

Objective To evaluate the clinical effects of pre-anesthetic intravenous injection of lipoprostaglandin E1 （Lipo-PGE1） on patients with intracranial aneurysm during embolization therapy. Methods Thirty-seven patients with intracranial aneurysm [Hunt-Hess Grade 0-Ⅱ and American Society of Anesthesiologists （ASA） Grade Ⅰ -Ⅱ ] adopted to be treated with embolization therapy were randomly divided into 2 groups, Lipo-PGE1 group （n= 18） and control group （n= 19）. In Lipo-PGE1 group, Lipo-PGE1 （0.20 μg/kg） was injected intravenously 1 h before operation. Midazolam （2.00 mg/kg, iv）, fentanyl （3.30μg/kg, iv）, vecuronium （0.13 mg/kg, iv） and etomidate （0.30 mg/kg, iv） were used for induced anesthesia. Remifentaniliva [0.20μg/（kg·min）, vd], propofol [0.07 mg/（kg·min）, vd] and rocuronium [30.00μg/（kg-min）, iv] were given to maintain anesthesia. Mean arterial pressure （MAP）, heart rate （HR）, respiratory rate （RR） and pulse oxygen saturation （SpOz） were monitored, while S-100 protein was measured before and 24 h after operation. Incidence of cerebrovascular spasm was recorded during operation. Resuscitation time and adverse reactions, such as nausea and shivering, and motor nervous function were evaluated after operation. Results The difference of vital signs between 2 groups was not significant at pre- and pro-operation （P〉0.05, for all）; During operation, the occurrence of cerebrovascular spasm in Lipo-PGE1 group （2 patients, 11.11%） was significantly lower than that in control group （9 patients, 47.37%） （P〈 0.05）. S-100 protein [（0.36±0.08） μg/L] and resus- citation time [（13.52±1.93） mini after operation in Lipo-PGE1 group were significantly lower than those in control group [（0.89 ±0.14） μg/L and （16.41 ±3.72） min respectively], P〈 0.01. Compared with pre-operation,S-100 protein was significantly higher in control group in pro-operation （P 〈 0.01）. In Lipo-PGE1 group, there was no significant difference of S-100 protein betweenpre- and pro-operation （P〉0.05）. After operation, cantly better than that in control group （P〈0.05）, LIPO-PGE1 possessed with target vasodilative action early resuscitation, and improve prognosis. motor nervous function in Lipo-PGE1 up was significantly better than that in control group（P〈0.05）,Conclusion Durng pre-operation, early application of can prevent secondary cerebrovascular spasm, promote early resuscitation,and improve prognosis.