控制性降压在神经外科手术的应用

Application of controlled hypotention in neurosurgery

目的 :探讨控制性降压在神经外科手术中的应用。方法 :选择ASAⅠ～Ⅱ级颅内手术患者 36例 ,按手术类型分为相类似的两组 :对照组 (A组 ) 18例和降压组 (B组 ) 18例。两组均采用气静复合麻醉 ,控制呼吸。B组在打开脑膜时开始降压至瘤体摘除 ,并于 30min内缓慢停用降压药。比较两组术中补液量、输血量、出血量以及术中去除瘤体后和术后生命体征平稳情况。结果 :两组一般情况和手术前、后血压、心率变化差异均无显著性 (P >0 .0 5 ) ;B组术中补液量、输血量、出血均显著少于A组 (P <0 .0 1) ;两组生命体征均平稳。结论 :神经外科手术中控制性降压可减少术中出血 ;缓冲脑组织回位 ,防止切除瘤体后引起心率剧烈波动 ,且减轻术后脑水肿。

Objective:To investigate the application of controlled hypotension in neurosurgery.Methods:Thirty six ASA Ⅰ～Ⅱ grade patients who underwent intracranial surgery were included in this study.They were divided into two groups according to the operation type:the control group(Group A, n =18) and the hypotentioned group(Group B, n =18).The two groups were all anesthetized venously and the breath were controlled.In group B,the blood pressure was lowered at the moment of openning the cerebral membrane till the tumor was removed.The liquid volume and blood volume which were infused and bleeding volume during the operation,the stability of vital signs just after the tumor was removed and after operation were all compared between the two groups.Results:There is no significant difference in the general situation,preoperative and postoperative blood pressure and heart rate between the two groups( P >0.05);The liquid volume and blood volume which were infused and bleeding volume during the operation were significantly less than those in group A( P <0.01);The vital signs were all stable in the two groups.Conclusions:In neurosurgery,the measure of controlled hypotention can reduce bleeding volume,prevent the heart rate from severely fluctuating after the tumor is removed so that it can reduce cerebral edema. [