控制性降压对颅内动脉瘤夹闭术病人血浆皮质醇醛固酮及血糖的影响

The Effects of Deliberate Hypotension on the Plasma Cortisol, Aldosterone and Glucose Levels in the Cerebral Aneurysm Patients during Surgical Intervention

目的和方法：选择４０例在ＮＬＡ麻醉下行控制性降压的颅内动脉瘤夹闭术病人，随机等分为前列腺素Ｅ１组和异氟醚组。两组控制性低血压幅度相似（ＭＡＰ分别降至８．７３±１．５６和８．８３±１．５４ｋＰａ）。结果：降压期间两组病人血浆皮质醇、醛固酮和血糖浓度较降压前明显增高（Ｐ＜０．０５），特别是剥离动脉瘤时皮质醇增高更是明显（Ｐ＜０．０１），手术结束时三者仍轻度增高。结论：在低血压下实施这种手术，只要手术侵袭和降压幅度相仿，所导致的应激反应也相似，并不因应用ＰＧＥ１或异氟醚降压而有所不同。

Objective and Methods: Forty cerebral aneurysm patients were operated under NLA anesthesia and randomly divided into two deliiberate hypotension groups. Prostaglandin E1(group Ⅰ n=20) and isoflurane (group Ⅱ n=20) were administered to reduce MAP to 873±156 and 883±154kPa respectively during the operations. Changes of plasma cortisol, aldosterone and glucose concertrations were investivated perioperatively. Results: The concentrations were all elevated in both groups during the period of hypotension, particularly more significantly increased during dissection of the aneurysm and maintained slightly elevated a short duration postoperatively. Conclusion:The magnitude of stress response to surgical invasion and hypotension are similar irrespect of the different drugs used to induce hypotension.