不同麻醉深度对颅内动脉瘤夹闭手术效果的影响研究

Influence of different anesthesia depth on the effect of intracranial aneurysm clipping

目的:研究不同麻醉深度对颅内动脉瘤夹闭手术效果的影响。方法:选取2015年5月至2017年5月间于河南省平顶山市第二人民医院(以下简称我院)接受颅内动脉瘤夹闭术治疗的患者86例为研究对象,依据随机数字表法分为深麻醉组和浅麻醉组各43例,对比两组患者在不同麻醉深度下的术中输血量、尿量、手术麻醉时间、及术后随访调查得到了术中知晓情况、S100β蛋白浓度水平和脑氧代谢情况。结果:两组患者的术中出血量、尿量、术中麻醉时间、术中知晓人数比较,差异无统计学意义(P>0.05);两组患者的心率(HR)和平均动脉压(MAP)血流动力学指标在各个时间点的组间和组内比较,差异无统计学意义(P>0.05);深麻醉组的异丙酚用量(1 527.3±309.6)mg显著高于浅麻醉组的(1 037.5±288.6)mg,脑电双频指数(BIS)(27.5±4.9)显著低于浅麻醉组的(45.3±6.8),差异有统计学意义(P<0.05);深麻醉组和浅麻醉组的S100β蛋白浓度在T_2、T_3和T_4时均显著高于T_0时,且深麻醉组的S100β蛋白浓度在T_2、T_3和T_4时均显著低于浅麻醉组,差异有统计学意义(P<0.05);两组患者血红蛋白(HGB)、动脉血氧分压(PaO_2)、颈内静脉血氧分压(PjvO_2)、动脉血氧饱和度(SaO_2)、颈内静脉血氧饱和度(SjvO_2)水平在组内各时间点以及两组间同一时间点对比,差异均无统计学意义(P>0.05);两组患者SjvO_2水平在T_1时均显著高于T_0时,且浅麻醉组在T_3、T_4时显著低于T_0时,同时深麻醉组的SjvO_2水平在T_3、T_4时均显著高于浅麻醉组,差异均有统计学意义(P<0.05);两组患者AVDO_2水平在T_1时显著低于T_0时,浅麻醉组在T_4时显著高于T_0时,差异均有统计学意义(P<0.05);深麻醉组的AVDO_2水平在T_2和T_4时均显著低于浅麻醉组,差异均有统计学意义(P<0.05)。结论:在脑动脉瘤夹闭术中,BIS维持到20~40左右的深度麻醉相对于轻度麻醉,能够明显降低血清中S100β蛋白水平,降低脑氧代谢失衡程度,能有效减轻手术时的颅脑损伤程度,起到更好的脑保护作用,值得在临床中进行广泛的推广。

Objective To study the influence of different anesthesia depth on the effect of intracranial aneurysm clipping. Methods Totally 86 patients who underwent intracranial aneurysm clipping in our hospital from May 2015 to May 2017 were enrolled in this study. According to random number table method the patients were divided into deep anesthesia group and shallow anesthesia group, with 43 in each group. The intraoperative blood transfusion volume, urine volume, operation anesthesia time and the intraoperative awareness, postoperative S100β protein concentration and cerebral oxygen metabolism obtained by follow-up survey of the two groups were compared. Results There were no significant differences in the intraoperative blood loss, urine volume, intraoperative anesthesia time and intraoperative volume between the two groups（P〉0.05）. The HR and MAP hemodynamics indexes of the two groups were not significantly different between the two groups at all the time points （P〉0.05）. The dose of propofol in the deep anesthesia group （1 537.3±309.6） mg was significantly higher than that in the shallow anesthesia group （1 037.5±288.6） mg, BIS value （27.5±4.9） was significantly lower than that in the shallow anesthesia group （45.3±6.8） （P〈0.05）. The concentrations of S100β protein in the deep anesthesia group and shallow anesthesia group at T2, T3 and T4 were significantly higher than that at T0, and the concentrations of S100β protein in the deep anesthesia group were significantly lower than that in the shallow anesthesia group at T2, T3 and T4 （P〈0.05）. There were no significant differences in the HGB, PaO2, PjvO2 and SaO2 levels between the two groups at the same time point or within the group at different time points （P〉0.05）. The level of SjvO2 at T1 in the deep anesthesia group was significantly higher than that at T0, the levels of SjvO2 at T1, T3 and T4 in the shallow anesthesia group were significantly higher than that at T0, and the levels of SjvO2 at T3 and T4 in the deep anesthesia group were significantly higher than those in the shallow anesthesia group （P〈0.05）. The levels of AVDO2 at T1 in the deep anesthesia group and shallow anesthesia group were significantly lower than those at T0 （P〈0.05）. The levels of AVDO2 at T2 and T4 in the deep anesthesia group were significantly lower than those in the shallow anesthesia group （P〈0.05）. Conclusion For cerebral aneurysm clipping, compared with mild anesthesia, deep anesthesia with BIS maintained at 20-40 can significantly reduce serum S100β protein levels and cerebral oxygen metabolism imbalance, thus effectively reduce skull brain damage, which may play a better role in the protection of brain and is worthy of wide clinical promotion.