去氧肾上腺素和去甲肾上腺素在烟雾病患者行颅内外血运重建术中的应用及对血流动力学平稳和脑灌注及脑梗死的影响

Effects of deoxyepinephrine and noradrenaline on the application of intracranial and extracranial revascularization for moyamoya disease and their influences on hemodynamic stability,cerebral perfusion and cerebral infarction

目的 探讨烟雾病患者行颅内外血运重建术中应用去氧肾上腺素和去甲肾上腺素对血流动力学平稳、脑灌注及脑梗死的影响。方法 随机选取2021年2月至2023年1月收治的98例烟雾病患者。采取随机数字表法分为对照组和观察组,每组49例。对照组患者采取术前静脉泵注去氧肾上腺素辅助麻醉及手术的方式。观察组行去甲肾上腺素辅助麻醉及手术。观察2组患者血流动力学指标、脑氧化谢指标、中枢神经功能障碍指标。结果 观察组血流动力学中的平均动脉压及中心静脉压与对照组比较无明显差异(P>0.05)。心率水平优于对照组(P<0.05)。观察组整体脑灌注(SjvO_(2)、DajvO_(2)、VADL)与对照组比较无明显差异(P>0.05)。观察组心动过缓等不良事件发生率低于对照组(P<0.05)。结论 烟雾病患者行颅内外血运重建术中应用去氧肾上腺素和去甲肾上腺素可有效维持血流动力学平稳,改善术中脑灌注水平,降低术后脑梗死发生率。

Objective To investigate the effects of deoxyepinephrine and noradrenaline on the hemodynamic stability,cerebral perfusion and cerebral infarction in revascularization of moyamoya disease(MMD).Methods In this study,98 MMD patients admitted from February 2021 to January 2023 were randomly selected and divided into the control group and observation group,with 49 cases per group.In the control group,assisted anesthesia by preoperative intravenous deadrenaline and surgery were performed.Patients in the observation group underwent norepinephrine-assisted anesthesia and surgery.Hemodynamic data,oxidative metabolism index and indicators of central nervous dysfunction were observed in both groups.Results The mean arterial pressure and central venous pressure were comparable between groups(P>0.05).The heart rate level was significantly better in the observation group than the control group(P<0.05).The overall cerebral perfusion performance,including jugular venous oxygen saturation(SjvO_(2)),the content of arterial venous difference(DajvO_(2)),and VADL,were similar between groups(P>0.05).The incidence of adverse events such as bradycardia in the observation group was significantly lower than that of the control group(P<0.05).Conclusion The application of deoxyepinephrine and noradrenaline in MMD can effectively maintain the stable hemodynamics,improve the intraoperative cerebral perfusion level,and reduce the incidence of postoperative cerebral infarction.