严格血压管理策略对颈动脉内膜剥脱术术中脑氧供需平衡的影响

doi:10.3969/j.issn.1006-7795.2016.04.023

摘要/Abstract

摘要： 目的观察严格血压管理策略对颈动脉内膜剥脱术患者脑氧供需平衡的影响。方法择期行颈动脉内膜剥脱术患者20例，年龄49～75岁，术前测定基础血压。术中平均动脉压（mean arterial pressure，MAP）调控目标：阻断前（T1）期血压维持在基础血压水平；阻断（T2）期血压维持在基础血压的+10%～+20%水平，且SBP<160 mmHg（1 mmHg=0.133 kPa）；解除阻断（T3）期血压维持在基础血压的-10%～-20%范围。记录麻醉诱导前10 min（T₀）、手术后20 min（T₁）、颈动脉阻断即刻（T₂）、颈动脉阻断15 min（T₃）、颈动脉开放即刻（T₄）、颈动脉开放10 min（T₅）、拔除气管插管后10 min（T₆）时平均动脉压、脑电双频指数（bispectral index，BIS）和双侧脑氧饱和度（regional cerebral oxygen saturation，rSO₂）。结果 T₀、T₁、T₂、T₃和T₄时间点的MAP分别为（94±9）mmHg、（94±14）mmHg、（105±10）mmHg、（102±14）mmHg和（84±12）mmHg，阻断期MAP较基础水平提升约11%（P<0.05），解除阻断后MAP较基础水平降低11%（P<0.05）；术侧rSO₂在以上各时间点为（70±4）%、（65±3）%、（64±5）%、（67±4）%和（69±4）%，T2期的rSO₂较基础值降低（P<0.05），但T₂、T₃和T₄各时间点之间差异无统计学意义（P>0.05）；同非术侧比较，术侧rSO₂在T₃和T₄点明显降低（P<0.05）。手术侧及非手术侧颈动脉阻断前后rSO₂下降<20%。结论颈动脉内膜剥脱术中，严格的血压调控能维持患者良好的脑氧供需平衡，防止脑缺血的发生。

关键词: 颈动脉内膜剥脱术, 脑氧饱和度, 脑缺血, 血压管理

Abstract: Objective To assess the effect of aggressive blood pressure management on regional cerebral oxygen saturation (rSO₂) of patients undergone carotid endarterectomy (CEA).Methods A total of 20 patients, aged from 49 to 75 years old, undergone CEA were included in the study. The baseline for MAP was calculated the day before surgery. The strategy of aggressive blood pressure management include that MAP was kept at baseline value during preclamp phase, elevated 10%-20% of baseline value during cross-clamp phase with SBP no more than 160 mmHg (1 mmHg=0.133 kPa) and then decreased 10%-20% of baseline value after clamp removal. Intraoperative bispectral index (BIS), rSO₂ monitoring were applied. The value of MAP, BIS and rSO₂ were recorded at different points of the surgery. Results The MAP was elevated about 11% of baselinevalue during clamping phase (P<0.05) and decreased about 11% of baseline value after clamp removal (P<0.05). The rSO₂ value detected from ipsilateral brain was significantly decreased during the cross-clamp phase (P<0.05), but the decreasing percentage in rSO₂ was less than 20% from preclamp value to cross-clamp value. Then, the rSO₂ was ameliorated to baseline value after clamp removal. Conclusion Aggressive blood pressure management is beneficial to improve rSO₂ for the patients undergoing CEA and prevent incidence of cerebral ischemia.

Key words: carotid endarterectomy, regional cerebral oxygen saturation (rSO₂), cerebral ischemia, blood pressure management

中图分类号:

R614

王云珍, 于斌, 韩如泉. 严格血压管理策略对颈动脉内膜剥脱术术中脑氧供需平衡的影响[J]. 首都医科大学学报, 2016, 37(4): 529-533.

Wang Yunzhen, Yu Bin, Han Ruquan. Aggressive blood pressure management on regional cerebral oxygen saturation in patients undergoing carotid endarterectomy[J]. Journal of Capital Medical University, 2016, 37(4): 529-533.

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