缺血性脑血管病行颅内外动脉架桥吻合术患者的临床麻醉分析

Clinical anesthesia of patients with ischemic cerebrovascular disease undergoing extracranial-intracranial bypass

目的基于对血流动力学的较大影响,颅内外动脉架桥吻合术的麻醉一直是临床外科的难点,本研究对72例行颅内外动脉架桥吻合术的缺血性脑血管病患者的临床麻醉方案进行客观分析,以期提高其临床麻醉处理水平。方法选择2011年1月—2013年12月72例行颅内外动脉架桥吻合术的缺血性脑血管患者,所有患者均行气管插管全身麻醉;观察麻醉效果和并发症,并对其麻醉前后电解质、血气及血流动力学指标进行对比分析。麻醉前后的对比数据均以(x±s)表示,使用统计学软件SPSS 16.0行t检验。结果 72例患者的麻醉诱导过程顺利、平稳,整个手术过程中,麻醉效果也持续平稳,整个手术麻醉过程中没有患者死亡;术后5例患者因并发肺部感染、多器官功能衰竭死亡,病死率为6.94%,其余67例患者均康复出院。此外,麻醉后,患者PO2、Na+显著高于麻醉前(t=8.563,10.542;P=0.010,0.001),PCO2、K+显著低于麻醉前(t=3.136,2.705;P=0.038,0.042),p H和HCO3-无显著差异(t=0.135,0.142;P=0.812,0.697);麻醉后,红细胞变形指数显著高于麻醉前(t=2.359,P=0.044),全血高切粘度、红细胞聚集指数显著低于麻醉前(t=5.063,2.648;P=0.013,0.043)。结论对于行颅内外动脉架桥吻合术的ICVD患者,应该加强其麻醉管理,降低手术的麻醉风险,提高患者的生存几率。

Objective To analyze the clinical anesthetic regimens of 72 cases of ischemic cerebrovascular disease （ICVD） undergoing extracranial-to-intracranial anastomosis,improve the level of the clinical anesthesia treatment. Methods 64 cases of ICVD admitted to ICU from January of 2011 to December of 2013 undergoing extracranial-to-intracranial anasto- mosis were enrolled in this study; all the patients were given tracheal intubation general anesthesia. The treatment meth- ods, results and complication were analyzed retrospectively. The electrolytes levels, blood gas and hemodynamic indexes before and after anesthesia were tested and compared by SPSS 16.0. Results After anesthesia, PO2 and Na ＋ of patients were significantly higher than those before anesthesia （ t = 8. 563,10.542 ;P = 0. 010,0. 001 ）, PCO2 and K＋~ were signifi- cantly lower than those before anesthesia（ t = 3. 136,2. 705 ;P = 0. 038,0.042）, pH and HCO3 - had no significant differ- ence（ t = 0. 135,0. 142 ;P = 0.812,0.697 ）. After anesthesia, erythrocyte deformability index （EDI） of patients were sig- nificantly higher than those before anesthesia（ t = 2. 359, P = 0.044）, while blood viscosity （ high cut） and erythrocyte ag- gregation index（EAI） were significantly lower than those before anesthesia（ t = 5. 063,2.648 ;P = 0. 013 ,0. 043 ）. No pa- tients died during the whole process of anesthesia. Postoperative, five patients died because of complicated with lung infec- tion and multiple organ failure, with a death rate of 6.94%, and the remaining 67 patients all recovered. Conclusion For the patients with ICVD undergoing extracranial-to-intracranial anastomosis, the anesthesia management should be improved to reduce the risk of surgery anesthesia, and improve the survival chances of patients.