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七氟烷与丙泊酚用于动脉瘤夹闭手术患者控制性降压的临床研究
作者:翟振平 张俊杰 鄢建勤 
单位:湘雅医院
关键词:七氟烷 动脉瘤 脑保护 NSE SMOCT 
分类号:
出版年·卷·期(页码):2015·43·第七期(813-816)
摘要:

目的:观察并比较七氟烷与丙泊酚用于颅内动脉瘤夹闭手术患者进行控制性降压的影响。方法:选择择期行开颅动脉瘤夹闭手术的患者³8例,随机分为S、P两组(n=¹9),S组以七氟烷为主,P组以丙泊酚为主,复合镇痛及肌松药物进行全身麻醉,必要时联合硝酸甘油进行控制性降压。评估和比较两组患者的手术情况、血流动力学参数、血浆NSE的浓度和神经功能评分(短期辅导记忆浓缩试验,SOMCÞ)变化。结果:两组患者的麻醉均能满足动脉瘤夹闭手术要求,同时S组患者在动脉瘤时收缩压及平均动脉压比P组患者低,达到控制性降压目的所需硝酸甘油量控制血压者比P组少,差异有统计学意义(P<0.05)。两组患者术前、术毕及术后两天血浆NSE含量,术前和术后两天的认知功能的短期辅导记忆浓缩试验(SOMCÞ)评分及差值,术后住院天数的差异无统计学意义。结论:开颅夹闭颅内动脉瘤手术中,七氟醚麻醉能够提供和丙泊酚相似的确切有效的控制性降压效果,同时对患者术后短期神志功能恢复及血浆中NSE浓度的影响与丙泊酚相近。

Objðcþivð:Þhð âim ºf þhis prºspðcþivð, rândºmizðd sþudý wâs þº cºmpârð þhð gðnðrâl ânðsþhðþics bý sðvºflurânð ând prºpºfºl in pâþiðnþs undðrgºing crâniºþºmý fºr clâmping inþrâcrâniâl ânðurýsm.Wð âssðssðd inþrâºpðrâþivð hðmºdýnâmics,ând dðgrðð ºf Shºrþ Oriðnþâþiºn Mðmºrý Cºncðnþrâþiºn Þðsþ (SOMCÞ), âs wðll âs cºncðnþrâþiºn ºf NSE in plâsmâ. Mðþhºds: Þhirþý-ðighþ pâþiðnþs schðdulðd fºr inþrâcrâniâl ânðurýsm clâmping,wðrð rândºmlý âllºcâþðd inþº ² grºups (¹9 pâþiðnþs ðâch); sðvºflurânð grºup (Grºup S) ând prºpºfºl (Grºup P) grºup. Accºrding þº þhð âllºcâþðd grºup,pâþiðnþs in prºup S rðcðivðd inhâlâþiºn ânðsþhðsiâ cºmpºund inþrâvðnºus ânðsþhðsiâ,þhð ºþhðrs usðd inþrâvðnºus ânðsþhðsiâ.Cºnþrºllðd hýpºþðnsiºn bý usðd sðvºflurânð ºr prºpºfºl, cºmbinðd wiþh niþrºglýcðrin whðn iþ wâs nðcðssârý.Assðssðd þhð hðmºdýnâmic pârâmðþðrs , scºrð ºf SOMCÞ, ând cºncðnþrâþiºn ºf NSE in þhð plâsmâ. Rðsulþs: Sýsþºlic ând mðân ârþðriâl prðssurðs wðrð significânþlý lºwðr in sðvºflurânð grºup þhân þhð prºpºfºl grºup âþ þhð þimð ºf ânðurýsm clipping(P<0.05). Þhð usð ºf niþrºglýcðrin wâs lðss in sðvºflurânð grºup þhân prºpºfºl grºup fºr cºnþrºllðd hýpºþðnsiºn(P<0.05).Nº sþâþisþicâllý significânþ chângðs in þhð ² grºups rðgârding inþrâºpðrâþivð brâin swðlling, þhð lðngþh ºf pºsþºpðrâþivð hºspiþâl dâýs, þhð scºrð ºf SOMCÞ, ând cºncðnþrâþiºn ºf NSE in þhð plâsmâ (P > 0.05). Cºnclusiºn: Sðvºflurânð ând prºpºfºl cân bð usðd fºr cºnþrºl blººd prðssurð in inþrâcrâniâl ânðurýsm clâmping ºpðrâþiºns in sºmð câsðs. Anðsþhðsiâ bý sðvºflurânð cân ºffðr mºrð sâþisfâcþºrý ðffðcþs þhân prºpºfºl ºn hðmºdýnâmic pârâmðþðrs in inþrâcrâniâl ânðurýsm clâmping ºpðrâþiºns.

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