动脉瘤术中脑组织氧代谢监测的临床研究

CLINICAL RESEARCH ON CEREBRAL OXYGENATION MONITORING DURING ANEURYSM SURGERY

目的 :探讨动脉瘤术中进行脑组织氧代谢监测的临床意义。方法 :2 0 0 0年 10月～ 2 0 0 2年 7月间对 2 0例颅内动脉瘤患者行动脉瘤夹闭术 ,术中对载瘤动脉进行临时阻断 ,并对被阻断动脉供血区持续进行脑组织氧代谢监测 ,比较临时阻断载瘤动脉前后PbtO2 、PbtCO2 和pH的变化。结果 :载瘤动脉临时阻断后 ,PbtO2 从 (2 2± 3)mmHg下降到 (14± 2 )mmHg(P >0 .0 1) ,PbtCO2 从 (4 6± 2 )mmHg升高到 (5 4± 3)mmHg(P >0 .0 1) ,pH从 7.10± 0 .0 3下降到 7.0 2± 0 .0 2 (P >0 .0 1)。而且 ,上述指标均在临时夹闭后 30s内就发生明显的变化。结论 :脑组织氧代谢监测是一种安全、可靠、灵敏的监测手段 ,可及时准确地发现因载瘤动脉被阻断而引起的脑组织缺血缺氧 ,并有助于术者调整临时阻断时间 ,从而防止临时阻断动脉造成医源性脑缺血损害。

Objective:To evaluate the clinical significance of cerebral oxygenation monitoring during aneurysm surgery.Methods:During 2-year period between October 2000 and July 2002,twenty patients with intracranial aneurysm were operated on with the aid of temporary arterial occlusion,and continuously intraoperative monitoring of brain tissue oxygen tension (P bt O 2), carbon dioxide tension (P bt CO 2) and pH value of the corresponding territories undergoing temporary arterial occlusion was carried out using Neurotrend-7. The mean value of P bt O 2, P bt CO 2 and pH after the brain arterial occlusion were compared with the baseline(before the brain arterial occlusion).Results:The mean value of P bt O 2, pH decreased from 22 ±3 mmHg and 7.10 ±0.02 to 14±2 and 7.02±0.02 respectively ( P >0.01) ,the mean value of P bt CO 2 increased from 46±2mmHg to 54±3mmHg ( P >0.01),and the changes of the above parameters were noticeable within 30 seconds after temporary clip application.Conclusion:Cerebral oxygenation monitoring is a safe ,reliable and sensitive technique; occlusion-induced ischemia is reliably detected within the 1st minute after clip application ;this may enable the neurosurgeon to alter the surgical strategy early after TAO to prevent iatrogenic ischemia brain damage.