神经外科术中硝普钠控制性降压期间血流动力学的变化

首都医科大学学报 ›› 2003, Vol. 24 ›› Issue (3): 323-325.

神经外科术中硝普钠控制性降压期间血流动力学的变化

焦希平, 邢燕, 王保国

首都医科大学附属北京天坛医院麻醉科

收稿日期:2002-12-30 修回日期:1900-01-01 出版日期:2003-07-15 发布日期:2003-07-15

Hemodynamic Changes during Controlled Hypotension Induced by Sodium Nitroprusside in Neurosurgical Patients

Jiao Xiping, Xing Yan, Wang Baoguo

Department of Anesthesiology, Beijing Tiantan Hospital, Affiliate of Capital University of Medical Sciences

Received:2002-12-30 Revised:1900-01-01 Online:2003-07-15 Published:2003-07-15

摘要/Abstract

摘要： 为观察神经外科术中硝普钠控制性降压(CH)对血流动力学的影响,对15例ASAⅠ～Ⅱ级无心肺疾患的择期颅脑手术病人(男5例,女10例,年龄19～55岁),术中吸入1.0MAC异氟醚维持麻醉。剪开硬膜后,需行控制性降压时,用微量泵输注硝普钠,初始量1.5～2μg/(kg·min),将平均动脉压(MAP)降至并维持在7.3～8.0kPa(55～60mmHg)。连续监测无创平均动脉压(MAP)、心率(HR)、心电图(ECG)、脉搏血氧饱和度(SpO₂)。用HEMOSONIC^TM100经食管连续监测血流峰速度(PV)、血流加速度(ACC)、左室射血时间(LVET)、每搏量(SV)、心输出量(CO),计算全身血管阻力(TSVR)。用气体浓度监测仪(Datex Ultima,芬兰)连续监测呼气末二氧化碳(PetCO₂)、SpO₂、呼气末异氟醚浓度。分别于降压前、降压达目标时、维持降压5、15和30min、停降压5、10min,采集血流动力学参数进行统计学处理。在控制性降压期间ACC、PV、CO、SV和HR较降压前增加20.8%～41.1%、18.1%～26.3%、21.6%～27.9%、2.7%～7.6%和20.5%～25.0%;TSVR下降35.1%～39.1%。结果提示:神经外科术中行硝普钠控制性降压具有起效快,作用强,心输出量增加,复压迅速等优点。

关键词: 硝普钠, 控制性降压, 血流动力学

Abstract: To observe the hemodynamic changes during controlled hypotension (CH) induced by sodium nitroprusside (SNP) in neurosurgical patients, fifteen ASA Ⅰ～Ⅱ patients (5 male, 10 female), aged 19～55 years, undergoing elective neurosurgery were enrolled in this study. Anesthesia was maintained with 1.0 MAC isoflurane. Controlled hypotension was performed after opening dura and the MAP was reduced and maintained to 7.3～8.0 kPa (55～60 mmHg) with continuous infusion of SNP at 1.5～2 μg/(kg·min) by micro pump (Grasby, England). MAP, HR, ECG, SpO₂ were monitored. HEMOSONIC^TM 100 Monitor was used to measure PV, Acc, LVET, SV, CO and TSVR. PetCO₂, MAC was continuously measured by gas monitor (Datex, Ultima, Fenland). Hymodynamic parameters were recorded before hypotension, 5 min, 15 min and 30 min during hypotension, and 5 min and 10 min after discontinuing hypotension. During controlled hypotension, ACC、PV、CO、SV and HR increased by 20.8%～41.1%, 18.1%～26.3%, 21.6%～27.9%, 2.7%～7.6% and 20.5%～ 25.0%, respectively, compared with those before hypotension. TSVR decreased by 35.1～39.1%. Controlled hypotension with SNP for neurosurgical patients possess several advantages such as fast onset of action, decreased peripheral resistance, increased cardiac function and easy recovery of blood pressure.

Key words: sodium nitroprusside, controlled hypotention, hemodynamics

中图分类号:

R614.2⁺4

焦希平;邢燕;王保国. 神经外科术中硝普钠控制性降压期间血流动力学的变化[J]. 首都医科大学学报, 2003, 24(3): 323-325.

Jiao Xiping;Xing Yan;Wang Baoguo. Hemodynamic Changes during Controlled Hypotension Induced by Sodium Nitroprusside in Neurosurgical Patients[J]. Journal of Capital Medical University, 2003, 24(3): 323-325.

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