尼莫地平对幕上肿瘤切除术患者围术期脑氧供需平衡的影响

Effect of intraoperative continuous nimodipine infusion on cerebral oxygen supply-consumption balance during supratentorial tumor resection

目的观察尼莫地平对幕上肿瘤切除术围术期脑氧供需平衡的影响。方法择期幕上肿瘤切除术患者24例,ASAⅠ～Ⅱ级,随机分为对照组(A组)和尼莫地平组(B组),每组12例。采用丙泊酚与瑞芬太尼复合全麻,B组在麻醉开始时用微量泵输注尼莫地平15μg/(kg.h),A组同时泵注生理盐水0.075 mL/(kg.h)。局麻下行足背动脉、颈内静脉球穿刺置管。分别于全麻诱导前(T1)、气管插管即刻(T2)、切开硬脑膜即刻(T3)、切硬脑膜后1h(T4)、缝硬脑膜时(T5)、术后1d(T6),共6个时点同步采集颈内静脉球部和足背动脉血,进行血气分析,并记录或计算血红蛋白(Hb);动脉与颈内静脉血氧饱和度(SaO2,SjvO2)、氧分压(PaO2,PjvO2)、血氧含量(CaO2,CjvO2)及血氧含量差(Ca-jvO2);脑氧摄取率(CERO2)。结果(1)两组患者组内比较,T2时点CaO2,Cj-vO2,PjvO2,SjvO2高于T1时点(P<0.01),Ca-jvO2,CERO2低于T1时点(P<0.01);而T6时点CaO2,CjvO2,Pj-vO2,SjvO2,Ca-jvO2低于T1时点(P<0.01),CERO2高于T1时点(P<0.05,P<0.01),差异有显著性;(2)两组患者组间比较,B组T6时点CjvO2、SjvO2高于A组(P<0.05,P<0.01),而其Ca-jvO2,CERO2显著低于A组(P<0.05,P<0.01),差异有显著性。(3)组内与组间其余时点参数差异均无显著性。结论输注尼莫地平对幕上肿瘤切除术术中脑氧供需平衡无明显影响;而能改善术后1 d所致的脑氧供需失衡。

Objective To evaluate the effect of intraoperative continuous nimodipine infusion on cerebral oxygen supply - consumption balance during supratentorial tumor resection. Methods Thtuenty - four ASA grade Ⅰ or Ⅱ patients aged 18 - 65 year undergoing excision of supratentorial glioma were randomly divided into 2 groups ： nimodipine group （ A, n = 12） and control group（ B ,n = 12）. Patients in group B were given continuous nimodipine infusion [ 15 μg/（ kg · h） ] before induction of anesthesia. Patients in group A were given continuous saline infusion [0. 075 mL/（ kg · h） ]. Systemic hemodynamics was monitored during operation. Left common carotid vein retrograde catheterization （deep sigmoid sinus） and dorsalis pedis artery puncture were performed under local anesthesia. Blood samples were taken from artery and jugular venous bulb immediately before induction of anesthesia （ T1, baseline ）, at intubation （ T2 ）, immediately before opening of dura （T3） ,lh after opening of dura （T4） ,at the closure of dura（TS） ,and 24h after operation（T6） for blood gas analysis and the result was recorded or calculated for Hb, SaO2, SjvO, PaO2, PjvO2, CaO2, CjvO2, Ca - jvO2, CERO2. Results （ 1 ） CaO2, CjvO2, PjvO2, SjvO2 at T2 were significantly higher than those at T1 （ P 〈 0. 01 ）. Ca - jvO2, CERO2 at T2 were significantly lower than at T1 （P 〈0. 01 ）. CaO2, CjvO2 ,PjvO2, SjvO2 ,Ca-jvO2 at T6 were significantly lower than those at T1 （ P 〈 0.01 ）. CERO2 at T6 was significantly higher than that at TI （ P 〈 0.05, P 〈 0. 01 ）. The differences were statistically significant. （2） At T6 time point, CjvO2 and SjvO2 in group B were significantly higher than that in group A （ P 〈 0. 05, P 〈 0. 01 ） ; Ca - jvO2 and CERO2 were significantly lower than those in group A （ P 〈 0.01 ）. The differences were statistically significant. （3） There were no statistically differences between intra -group comparison and between the two groups in other parameters. Conclusion Nimodipine infusion does not influence cerebral oxygen of supply - consumption in patients with supratentorial tumor during operation, but it improves cerebral oxygen of supply - consumption on the first day after operation.