脑血管病患者神经介入治疗的麻醉管理

Anesthetic management of accepted patients with cerebralvascular diseases in endovascular treatment

目的 研究各类脑血管病患者神经介入治疗的麻醉管理方法。 方法 按美国麻醉医师协会(ASA)分级标准为Ⅰ-Ⅲ级的498例脑血管病手术患者,将气管内插管全麻的453例分为四组。A组:颅内动脉瘤(蛛网膜下腔出血)140例;B组:脑血管畸形(AVM)100例;C组:硬脑膜动静脉瘘(DAVF)120例;D组:脑梗塞、脑血管狭窄、脑缺血93例。全部患者均采用静脉加吸入复合全身麻醉(咪哒唑仑+普鲁泊福+异氟烷+维库溴铵或阿曲库铵)和其他麻醉,同时应用控制性降压。分别记录患者的年龄、体重、压宁定用量及给药前,手术开始、术中30min、60min、手术结束及拔管时的血压、心率、血氧饱合度、呼气末二氧化碳分压,并进行统计学处理。 结果 453例患者麻醉后血压、心率均有不同程度的下降,各组与给药前差异有显著性意义(P<0.05);尤其是颈动脉狭窄球囊扩张或支架置入,差异有非常显著性意义(P<0.01);脑血管畸形患者年龄为(30±14)岁,比其他各组患者年轻(P<0.01)。 结论 气管内插管静脉十吸入复合全麻安全、可控性好。

Objective To study anesthetic management of patients with various cerebralvascular diseases in endovascular treatment. Methods 498 patients were operated, ASA physical status Ⅰ- Ⅲ, in which 453 patients that received endotracheal anesthesia were divided into four groups. Group A: aneurysmal subarach-noid hemorrhage(SAH), n = 140; Group B: arteriovenous malformations (AVM), n = 100; Group C: dural arteri-ovenous fistula (DAVF), n = 120; Group D: cerebral infarction, cerebral vascular stenosis, transient ischemic attack (TIA), n = 93. The whole group received intravenous combined with inhalation anesthesia (midazolam, isoflu-rane and vecuronium or atracurium) and other anesthetic methods with controlled hypotension. The patients' name, age, weight and the dosage of ebrantil were recorded respectively ; Blood pressure(BP), heart rate(HR), oxygen saturation (SpO2) and end trial carbon dioxide concentration(EtCO2) were measured before induction of anaesthesia, at the commencement of operation, at 30 min, at 60 min, at the end of operation and at extubation . Results 453 patients' Bp and HR declined more or less after anesthesia. For all groups significant differences occurred between pre-induction value and post-induction value (P<0. 05) ; Especially in the group of carotid stenosis treated by balloon angioplasty and stenting (P<0. 01); The patients with cerebral arteriorvenous malformation are youger than other groups (P<0. 01) Conclusion Intravenous combined inhalation anesthesia is safe and can be feasibly managed.