尼莫地平对幕上肿瘤切除术患者围术期脑氧供需平衡的影响

[摘要] 目的 观查尼莫地平对幕上肿瘤切除术围术期脑氧供需平衡的影响。方法 择期幕上肿瘤切除术患者30例，ASAⅠ～Ⅱ级，随机分为对照组（A组）和尼莫地平（B组），每组15例。采用丙泊酚与瑞芬太尼复合全麻，B组在麻醉开始时用微量泵输注尼莫地平15μg∕(㎏oh)，A组同时泵注生理盐水0.075 ml∕(㎏oh)。局麻下行足背动脉、颈内静脉球穿刺置管。分别于全麻诱导前（T1）、气管插管即刻（T2）、切开硬脑膜即刻（T3）、切硬脑膜后1h（T4）、缝硬脑膜时（T5）、术后1d（T6），共6个时点同步采集颈内静脉球部和足背动脉血，进行血气分析，并记录或计算血红蛋白（Hb）；动脉与颈内静脉血氧饱和度（SaO2 、SjvO2）、氧分压（PaO2 、PjvO2）、血氧含量（CaO2、CjvO2）及血氧含量差（Ca-jvO2）；脑氧摄取率（CERO2）。结果 ①两组患者组内比较，T2时点CaO2、CjvO2、PjvO2 、SjvO2 高于T1时点（P < 0.01），Ca-jvO2、CERO2低于T1时点（P < 0.01）；而T6时点CaO2、CjvO2、PjvO2 、SjvO2 、Ca-jvO2 低于T1时点（P < 0.01），CERO2高于 T1时点（P < 0.05， P < 0.01），差异有统计学意义；②两组患者组间比较，B组T6时点CjvO2、SjvO2高于A组（P<0.05，P < 0.01），而其Ca-jvO2、CERO2显著低于A组（P<0.05，P<0.01），差异有统计学意义。③组内与组间其余时点参数差异均无统计学意义。结论 输注尼莫地平对幕上肿瘤切除术术中脑氧供需平衡无明显影响；而能改善术后1 d所致的脑氧供需失衡。

Effect of intraoperative continuous nimodipine infusion on cerebral oxygen supply-consumption balance during supratentorial tumor resection

[Abstract] objective To evaluate the effect of intraoperative continuous Nimodipine infusion on cerebral oxygen supply-consumption balance during supratentorial tumor resection. Methods Thirty ASA gradeⅠorⅡpatients aged 18~65 year undergoing excision of supratentorial glioma were randonmly divided into 2 groups: nimodipine group (A，n=15)and control group(B，n=12). The patients in group B were given Nimodipine infusion continuously(15μgo㎏-1oh-1)before anesthesia induction. The patients in group A were given saline infusion continuously(0.075mlo㎏-1oh-1). Systemic hemodynamics were monitored during the operation. Local anesthesia after the left common carotid vein retrograde catheterization (deep sigmoid sinus)，the dorsalis pedis artery puncture. Blood samples were taken from artery and jugular venous bulb simultaneously before induction of anesthesia (T1,baseline)，at intubation (T2)，open dura instantly (T3)，open dura after1h(T4)，at the closure of dura(T5)，and 24h after operation(T6) ，for blood gas analysis and it were recorded or calculated Hb， SaO2 、，SjvO，PaO2 ，PjvO2，CaO2，CjvO2 ，Ca-jvO2，CERO2 . Results (1)Two groups of patients with CaO2，CjvO2，PjvO2 ，SjvO2 T2 were significantly higher than T1(P <0.01)，Ca-jvO2，CERO2 T2 significantly lower than T1(P <0.01). CaO2，CjvO2，PjvO2 ，SjvO2 ，Ca-jvO2T6 significantly lower than T1(P <0.01)，CERO2 T6 significantly higher than T1 (P < 0.05， P < 0.01），the differences was statically significant. (2)Between the two groups at T6 time points CjvO2，SjvO2 B groups were significantly higher than A groups (P < 0.05， P < 0.01）；Ca-jvO2 ，CERO2 significantly lower than A groups（P < 0.01），the differences was statically significant. (3) There was no statistically difference between intra-group comparisons and between the two groups in other parameter. Conclusion There was no significantly influence on cerebral oxygen of supply-consumption using nimodipine infusion in patients with supratentorial tumor during operation. but it can improve cerebral oxygen of supply-consumption in the first day after operation .