应用控制性降压降低脑动静脉畸形术后脑过度灌注

Controlled Hypotension Decreases the Cerebral Luxury Perfusion after Arteriovenous Malformation Removal

目的 :应用手术切除脑动静脉畸形 (AVM)病灶后给予控制性低血压的方法 ,观察病灶周围脑组织的灌流情况 ,探讨术后脑肿胀发生的可能防治措施。方法 :选择病灶最大径≥ 6cm的AVM病人 8例 ,在术中AVM切除后 ,激光多普勒血流测定仪显示病灶周围脑组织高灌注时给予静脉推注 2 5 %硫喷妥钠 5～ 10mg/kg ,促使血压在原基础上下降 2 5 %左右 ,观察病灶周围脑组织的灌注情况。结果 :8例AVM的基础平均血压为 77 6 3± 4 2 7mmHg ,脑血流基础值为 35～ 134PU(灌流单位 ,penfusionunit)。AVM切除后 ,脑血流明显增加 ,变值 1为 12 5～ 434PU ,较基础值上升 2 2 3 48%± 0 6 2 % (P <0 0 0 1)。注射硫喷妥钠后 ,MAP降至 6 0 10± 3 6 4mmHg ,降幅为 2 3 0 0 %± 0 0 2 % ;脑血流量亦有所下降 ,变值 2为 89～ 2 36PU ,较未用药前下降 35 %± 7 35 % (P <0 0 1)。结论 :巨大型AVM切除即刻开始给予适当地控制血压 ,能明显降低脑血流值的上升幅度 。

Objective:To study the effect of controlled hypotention on the prevention and treatment of cerebral swelling after removal of giant arteriovenous malformation(AVM).Methods:8 cases with AVM(>6cm) were selected.When Laser Dopple flowmetry showed an increase of cerebral blood flow after excision arteriovenous malformation (AVM), intraoperatively,2 5% thiopental 5 10mg/kg was injected.Results:The basic mean blood pressure of all cases was 77 63±4 27mmHg and basic cerebral blood flow value was 35 134PU.After AVM resection,cerebral blood flow was increased obviously.The change value 1 was 125 434PU and the increasing amplitude was 223 48%±0 62%( P< 0 001).With thiopental injection,mean artery blood pressure was reduced by 23 00%±0 02%.The cerebral blood flow value was reduced too.The change value 2 was 89 236PU and the decreasing amplitude was 35%±7 35%( P< 0 01) campared with that before thiopental injection.Conclusion:Controlled hypotension can decrease the increasing amplitude of cerebral blood flow and the cerebral perfusion after the giant AVM removal.