多功能经颅骨颅内穿刺针持续颅内压监测在颅脑创伤全麻诱导期的指导意义
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摘要
目的对比采用多功能经颅骨颅内穿刺针持续颅内压(ICP)监测对不同全身麻醉(全麻)诱导方式行的指导。方法对颅脑创伤手术患者术前行快速ICP监测,其中男39例,女33例,随机数字表法分为常规诱导组(丙泊酚)和依托咪酯组,根据动态监测脑灌注压(CPP)和ICP观察两种诱导药物使用后的变化,以调整诱导药物使用。术前利用多功能经颅骨颅内穿刺针监测ICP、CPP;比较两组患者麻醉前(T0)、诱导中(T1)、插管前(T2)、插管时(T3)、插管后(T4)患者平均动脉压(MAP)、ICP、CPP、心率(HR)的变化。结果在麻醉诱导前两组ICP、MAP、CPP、HR、血氧饱和度(SpO2)指数均差异无统计学意义(P>0.05)。麻醉诱导后两组各指标均出现不同程度的变化,MAP、CPP下降程度更显著(P<0.05)。两组ICP、MAP及CPP在不同时间点(T1、T2、T3)变化差异有统计学意义(P<0.05)。结论运用多功能经颅骨颅内穿刺针ICP传感器置入在颅脑创伤手术中可有效地监测ICP、CPP变化,并能指导调整全麻诱导期药物的使用。
Objective To compare the guidance of multi-functional intracranial puncture needles for transcranial intracranial pressure(ICP)monitoring to different general anesthesia induction modes.Methods The preoperative fast ICP monitoring was conducted in the patients undergoing traumatic brain surgery.Among them,there were 39 males and 33 females.They were randomly divided into the conventional induction group(propofol)and the etomidate group.According to the dynamic monitoring of cerebral perfusion pressure(CPP)and ICP,the changes after two induction drugs use were observed to adjust the induction drug use.Before surgery,ICP and CPP were monitored by multi-functional transcranial intracranial puncture needles.The changes of mean arterial pressure(MAP),ICP,CPP and heart rate(HR)before anesthesia(T0),during the induction(T1),before the catheterization(T2),intubation(T3)and after intubation(T4)were compared between the two groups.Results ICP,MAP,CPP,HR,and SpO2 indexes before induction of anesthesia had no statistical differences between the two groups(P>0.05).After induction of anesthesia,various indexes of the two groups appeared varying degrees of changes.The MAP and CPP decreased degree were more significant(P<0.05).ICP,MAP and CPP at different time points(T1,T2,T3)had statistical differences between the two groups(P<0.05).Conclusion The use of multi-function transcranial intracranial puncture needle ICP sensor implantation can effectively monitor the changes of ICP and CPP,moreover can guide to adjust the drug use during anesthesia induction period.
Objective To compare the guidance of multi-functional intracranial puncture needles for transcranial intracranial pressure(ICP)monitoring to different general anesthesia induction modes.Methods The preoperative fast ICP monitoring was conducted in the patients undergoing traumatic brain surgery.Among them,there were 39 males and 33 females.They were randomly divided into the conventional induction group(propofol)and the etomidate group.According to the dynamic monitoring of cerebral perfusion pressure(CPP)and ICP,the changes after two induction drugs use were observed to adjust the induction drug use.Before surgery,ICP and CPP were monitored by multi-functional transcranial intracranial puncture needles.The changes of mean arterial pressure(MAP),ICP,CPP and heart rate(HR)before anesthesia(T0),during the induction(T1),before the catheterization(T2),intubation(T3)and after intubation(T4)were compared between the two groups.Results ICP,MAP,CPP,HR,and SpO2 indexes before induction of anesthesia had no statistical differences between the two groups(P>0.05).After induction of anesthesia,various indexes of the two groups appeared varying degrees of changes.The MAP and CPP decreased degree were more significant(P<0.05).ICP,MAP and CPP at different time points(T1,T2,T3)had statistical differences between the two groups(P<0.05).Conclusion The use of multi-function transcranial intracranial puncture needle ICP sensor implantation can effectively monitor the changes of ICP and CPP,moreover can guide to adjust the drug use during anesthesia induction period.
引文
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[10]DI BATTISTA A P,RHIND S G,HUTCHISOU M G,et al.Inflam-matory cytokine and chemokine profiles are associated with patient outcome and the hyperadrenergic state fol-lowin acute brain injury[J].J Neuroinflammation,2016,13(1):40-42.
[11]陈一丁,谭小红,王志仪,等.麻醉快速诱导药物对颅内肿瘤患者颅内压和脑灌注压的影响[J].东南大学学报:医学版,2012,31(1):35-39.
[12]FARAHVAR A,GERBER L M,CHIU Y L,et al.Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring[J].J Neurosurg,2012,117(4):729-734.
[13]HAWTHORNE C,PIPER I.Monitoring of intracranial pressure in patients with traumatic brain injury.Monitoring of intracranial pressure in patients with traumatic brain injury[J].Front Neurol,2014,5(1):121.
[14]章翔.重型颅脑损伤患者持续颅内压和脑灌注压监护的临床意义[J].中华创伤杂志,2000,16(12):3-6.
[15]李燕,王志杰,钟秀珍.脑外科手术的麻醉处理[J].中国医药指南,2013,26(26):115-116.
[16]SHAH N K,HARRIS M,GOVINDUGARI K,et al.Effect of propofol titration v/s bolus during induction of anesthesia on hemodynamics and bispectral index[J].Middle East J Anaesthesiol,2011,21(2):275-281.
[2]胡玉红.肌肉松弛剂和阿片类药物麻醉诱导对颅内肿瘤患者颅内压及脑灌注压的影响[J].西北国防医学杂志,2012,33(5):525-526.
[3]MENDELSON A A,GILLIS C,HENDERSON W R,et al.Intracranial pressure monitors in traumatic brain injury:a systematic review[J].Can J Neurol Sci,2012,39(5):571-576.
[4]OSHOROV A V,GORYACHEV A S,POPUGAEVКA.Mean ICP,ICP amplitude,mean AP and mean CPPdynamic in changing the position of the head of the bed in patients with severe TBI[J].Anesteziol Reanimatol,2012(4):68-72.
[5]徐小川.微创颅内压传感器植入术[J].重庆医学,2005,34(11):1643-1643.
[6]ABDELGAWAD A F,SHI Q F,HALAWA M A,et al.Comparison of cardiac output and hemodynamic responses of intubation among different videolaryngoscopies in normotensive and hypertensive patients[J].J Huazhong Univ Sci Technolog Med Sci,2015,35(3):432-438.
[7]KUNDRA S,MAHENDRU V,GUPTA V,et al.Principles of neuroan-esthesia in aneurysmal subaraehnoid hemorrh age[J].J Anaesthesiol Clin Pharmacol,2014,30(3):328-337.
[8]周强,蒋栋毅,陈寒春.持续颅内压监护和脑灌注压监护在重型颅脑损伤中的临床应用[J].中国现代手术学杂志,2011,15(5):386-388.
[9]王银生,张中原,张久蛟,等.有创颅内压监测在重型颅脑创伤救治中的应用价值[J].中国微创外科杂志,2013,13(3):279-281.
[10]DI BATTISTA A P,RHIND S G,HUTCHISOU M G,et al.Inflam-matory cytokine and chemokine profiles are associated with patient outcome and the hyperadrenergic state fol-lowin acute brain injury[J].J Neuroinflammation,2016,13(1):40-42.
[11]陈一丁,谭小红,王志仪,等.麻醉快速诱导药物对颅内肿瘤患者颅内压和脑灌注压的影响[J].东南大学学报:医学版,2012,31(1):35-39.
[12]FARAHVAR A,GERBER L M,CHIU Y L,et al.Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring[J].J Neurosurg,2012,117(4):729-734.
[13]HAWTHORNE C,PIPER I.Monitoring of intracranial pressure in patients with traumatic brain injury.Monitoring of intracranial pressure in patients with traumatic brain injury[J].Front Neurol,2014,5(1):121.
[14]章翔.重型颅脑损伤患者持续颅内压和脑灌注压监护的临床意义[J].中华创伤杂志,2000,16(12):3-6.
[15]李燕,王志杰,钟秀珍.脑外科手术的麻醉处理[J].中国医药指南,2013,26(26):115-116.
[16]SHAH N K,HARRIS M,GOVINDUGARI K,et al.Effect of propofol titration v/s bolus during induction of anesthesia on hemodynamics and bispectral index[J].Middle East J Anaesthesiol,2011,21(2):275-281.