艾司洛尔用于面神经微血管减压术中改善脑搏动的处理体会

Experience on esmolol improving brain beat during microvascular decompression surgery for hemifacial spasm

目的 比较艾司洛尔和乌拉地尔两种药物在面神经微血管减压术中出现脑搏动时的处理效果.方法 择期行面神经微血管减压术226例,常规采用气管内全麻,术中进行血压调控,维持平均动脉压55～65 mmHg（1 mmHg=0.133kPa）,并保持脑电双频指数（bispectral index,BIS）值在40～60之间.226例面神经微血管减压术患者术中打开硬脑膜后共出现明显脑搏动32例,运用简单随机化分组方法将32例患者分成3组,A组（11例）静脉内单次给予艾司洛尔10 mg,B组（11例）静脉内单次给予乌拉地尔5 mg,C组（10例）静脉内单次给予生理盐水2 mL.观察并记录注射前及注射后1 min、5 min、10 min、30 min时各组患者的心率（HR）、平均动脉压（MAP）及心输出量（CO）的变化,术中显微镜操作时间以及脑搏动的改善情况.结果 3组患者出现脑搏动时的HR、MAP和CO组间比较差异无统计学意义.A组11例患者静脉注射艾司洛尔后,各时间点HR和CO均明显下降,与C组比较差异有统计学意义（P＜0.01）,而MAP与C组比较差异无统计学意义;C组患者给予生理盐水处理后各时间点HR、CO和MAP均无明显变化.药物干预后A组脑搏动改善率高于B组和C组（P＜0.01）;A组显微镜操作时间为（18±4）min,明显短于B组[（28±6）min]和C组[（29±5）min].结论 艾司洛尔能显著降低面神经微血管减压术中脑搏动.

Objective To compare the efficacies of esmolol and urapidial in improving brain beat during microvascular decompression surgery for hemifacial spasm.Methods A total of 226patients scheduled for microvascular decompression surgery received general anesthesia with controlled blood pressure,with the mean arterial blood pressure(MAP)being 55-65 mmHg(1mmHg=0.133kPa)and the bispectral index being 40-60.Thirty-two of the 226patients who developed brain beat were randomly assigned to 3groups:group A(esmolol,n=11),B(urapidial,n=11)and C(isotonic NaCl,n=10), receiving intravenous injection of esmolol 10mg,urapidial 5mg and isotonic NaCl 2mL,respectively.The heart rate(HR), mean arterial pressure(MAP)and cardiac output(CO)at T0(before injection),T1(1min after injection),T2(5min after injection),T3(10min after injection),T4(30min after injection),operating time under microscope,and improvement of brain beat were observed.Results There were no significant differences in HR,MAP or CO at T0time between the three groups.HR and CO were significantly decreased in group A compared with those in group C at all time points(P<0.01);MAP values were similar between group A and group C.HR,MAP and CO were similar at different time points in group C.The improvement rate of group A was significantly higher than those of group B and group C(P<0.01).The operating time under microscope in group A was(18±4) min,which was significantly shorter than those in group B([28±6]min)and group C([29±5]min).Conclusion Esmolol can notably improve the brain beat during microvascular decompression surgery for hemifacial spasm.