开颅动脉瘤夹闭术中收缩和舒张脑血管因子研究

Alterations in cerebral vascular contracting and relaxing factors in the plasma during craniotomy and aneurysmal clipping

目的 观察颅内动脉瘤患者行夹闭术中血管紧张素II(AT II)、内皮素 (ET)和降钙素基因相关肽 (CGRP)的变化。方法 6 2例颅内动脉瘤患者拟行择期开颅动脉瘤夹闭术。分别于术前、剪硬膜、夹闭动脉瘤和动脉瘤夹闭后 30min 4个时间点采集动脉血 ,应用放免法检测血浆中AT II、ET和CGRP的浓度。结果 4个时间点AT II均在正常值范围。ET于术中 3个时间点即剪硬膜、夹闭动脉瘤和动脉瘤夹闭后 30min分别明显低于术前基础值 (P值分别为 0 .0 0 2、0 .0 0 1和 0 .0 0 9)。术前CGRP高于正常值 ,术中 3个时间点CGRP较术前基础值有所降低但无统计学差异。结论 目前开颅动脉瘤夹闭术中缩血管因子不升高 ,但舒血管因子有所降低 ,提示术中应注重扩血管治疗 。

Objective To observe the change of angiotensin II (AT-II), endothelin (ET), and calcitonin gene-related peptide (CGRP) during craniotomy and aneurysmal clipping.Methods 62 patients scheduled for selective craniotomy and aneurysmal clipping were included in this study. Plasma concentration of AT-TT, ET, and CGRP was measured with radioimmunoassay at the time points of pre-operation, dura opening, aneurysmal clipping, and 30 minutes after aneurysmal clipping, respectively.Results Plasma concentration of AT-II was in normal range throughout the study. ET decreased significantly during craniotomy and aneurysmal clipping compared with the baseline (P=0.002, 0.001, and 0.009). The baseline of CGRP was higher than the normal value. CGRP decreased during the surgery compared with the baseline, but no significant difference was found in the study.Conclusion Cerebral vasoconstrictors did not increase, however, vasodilator decreased during surgery. It is suggested that vasodilatory treatmeant shoud be considered during craniotomy and aneurysmal clipping in order to prevent acute cerebral vasospasm.