缺血性脑血管病行颅内外动脉架桥吻合术患者的临床麻醉分析
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摘要
目的基于对血流动力学的较大影响,颅内外动脉架桥吻合术的麻醉一直是临床外科的难点,本研究对72例行颅内外动脉架桥吻合术的缺血性脑血管病患者的临床麻醉方案进行客观分析,以期提高其临床麻醉处理水平。方法选择2011年1月—2013年12月72例行颅内外动脉架桥吻合术的缺血性脑血管患者,所有患者均行气管插管全身麻醉;观察麻醉效果和并发症,并对其麻醉前后电解质、血气及血流动力学指标进行对比分析。麻醉前后的对比数据均以(x±s)表示,使用统计学软件SPSS 16.0行t检验。结果 72例患者的麻醉诱导过程顺利、平稳,整个手术过程中,麻醉效果也持续平稳,整个手术麻醉过程中没有患者死亡;术后5例患者因并发肺部感染、多器官功能衰竭死亡,病死率为6.94%,其余67例患者均康复出院。此外,麻醉后,患者PO2、Na+显著高于麻醉前(t=8.563,10.542;P=0.010,0.001),PCO2、K+显著低于麻醉前(t=3.136,2.705;P=0.038,0.042),p H和HCO3-无显著差异(t=0.135,0.142;P=0.812,0.697);麻醉后,红细胞变形指数显著高于麻醉前(t=2.359,P=0.044),全血高切粘度、红细胞聚集指数显著低于麻醉前(t=5.063,2.648;P=0.013,0.043)。结论对于行颅内外动脉架桥吻合术的ICVD患者,应该加强其麻醉管理,降低手术的麻醉风险,提高患者的生存几率。
Objective To analyze the clinical anesthetic regimens of 72 cases of ischemic cerebrovascular disease( ICVD)undergoing extracranial-to-intracranial anastomosis,improve the level of the clinical anesthesia treatment. Methods 64 cases of ICVD admitted to ICU from January of 2011 to December of 2013 undergoing extracranial-to-intracranial anastomosis were enrolled in this study; all the patients were given tracheal intubation general anesthesia. The treatment methods,results and complication were analyzed retrospectively. The electrolytes levels,blood gas and hemodynamic indexes before and after anesthesia were tested and compared by SPSS 16. 0. Results After anesthesia,PO2 and Na+of patients were significantly higher than those before anesthesia( t = 8. 563,10. 542; P = 0. 010,0. 001),PCO2 and K+were significantly lower than those before anesthesia( t = 3. 136,2. 705; P = 0. 038,0. 042),p H and HCO3-had no significant difference( t = 0. 135,0. 142; P = 0. 812,0. 697). After anesthesia,erythrocyte deformability index( EDI) of patients were significantly higher than those before anesthesia( t = 2. 359,P = 0. 044),while blood viscosity( high cut) and erythrocyte aggregation index( EAI) were significantly lower than those before anesthesia( t = 5. 063,2. 648; P = 0. 013,0. 043). No patients died during the whole process of anesthesia. Postoperative,five patients died because of complicated with lung infection and multiple organ failure,with a death rate of 6. 94%,and the remaining 67 patients all recovered. Conclusion For the patients with ICVD undergoing extracranial-to-intracranial anastomosis,the anesthesia management should be improved to reduce the risk of surgery anesthesia,and improve the survival chances of patients.
Objective To analyze the clinical anesthetic regimens of 72 cases of ischemic cerebrovascular disease( ICVD)undergoing extracranial-to-intracranial anastomosis,improve the level of the clinical anesthesia treatment. Methods 64 cases of ICVD admitted to ICU from January of 2011 to December of 2013 undergoing extracranial-to-intracranial anastomosis were enrolled in this study; all the patients were given tracheal intubation general anesthesia. The treatment methods,results and complication were analyzed retrospectively. The electrolytes levels,blood gas and hemodynamic indexes before and after anesthesia were tested and compared by SPSS 16. 0. Results After anesthesia,PO2 and Na+of patients were significantly higher than those before anesthesia( t = 8. 563,10. 542; P = 0. 010,0. 001),PCO2 and K+were significantly lower than those before anesthesia( t = 3. 136,2. 705; P = 0. 038,0. 042),p H and HCO3-had no significant difference( t = 0. 135,0. 142; P = 0. 812,0. 697). After anesthesia,erythrocyte deformability index( EDI) of patients were significantly higher than those before anesthesia( t = 2. 359,P = 0. 044),while blood viscosity( high cut) and erythrocyte aggregation index( EAI) were significantly lower than those before anesthesia( t = 5. 063,2. 648; P = 0. 013,0. 043). No patients died during the whole process of anesthesia. Postoperative,five patients died because of complicated with lung infection and multiple organ failure,with a death rate of 6. 94%,and the remaining 67 patients all recovered. Conclusion For the patients with ICVD undergoing extracranial-to-intracranial anastomosis,the anesthesia management should be improved to reduce the risk of surgery anesthesia,and improve the survival chances of patients.
引文
[1]郭二伟.缺血性脑血管病临床分析与治疗探讨[J].中国医药指南,2011,9(26):121-122.
[2]毛晓茹.急性颅脑损伤临床麻醉处理分析[J].现代预防医学,2010,37(5):961-962.
[3]肖仙丰.浅谈急性颅脑损伤患者的临床麻醉[J].中国医药指南,2011,9(19):187-188.
[4]王明盛.颅内外动脉吻合治疗缺血型脑血管病25例临床分析[J].中国实用神经疾病杂志,2012,15(12):17-19.
[5]Khoo K,Lepas B.Summary of evidence-based guideline:Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease:report of the Guideline Development Subcommittee of the American Academy of Neurology[J].Neurology,2014,82(1):95.
[6]杨天涛.急性颅脑损伤患者的麻醉处理[J].中西医结合心脑血管病杂志,2009,7(12):1505-1506.
[7]Jeffree RL,Stoodley MA.STA-MCA bypass for symptomatic carotid occlusion and haemodynamic impairment[J].J Clin Neurosci,2009,16(2):226-235.
[8]裘伟琪,乐海伟.急性颅脑损伤手术的麻醉处理[J].浙江创伤外科,2010,15(2):246-247.
[9]马占君.急性颅脑损伤临床麻醉处理分析[J].医学新知杂志,2010,20(4):371-372.
[10]白先武.120例缺血性脑血管病临床分析与治疗探讨[J].中国现代药物应用,2010,4(8):71-72.
[11]罗永温.急性颅脑损伤临床麻醉处理分析[J].吉林医学,2011,32(8):3742-3743.
[12]Baron J,Yamauchi H,Fujioka M,et al.Selective neuronal loss in ischemic stroke and cerebrovascular disease[J].J Cereb Blood Flow Metab,2014,34(1):2-18.
[13]段立杰.急性颅脑损伤麻醉处理78例分析[J].中国误诊学杂志,2010,14(4):908-909.
[14]裴远宾.瑞芬太尼在急性颅脑损伤手术中的麻醉效果分析[J].医药论坛杂志,2011,32(11):148-149.
[15]徐彦华,孙雪莲,汪丽静,等.缺血性脑血管病临床60例治疗体会[J].中国现代药物应用,2013,7(19):72-73.
[2]毛晓茹.急性颅脑损伤临床麻醉处理分析[J].现代预防医学,2010,37(5):961-962.
[3]肖仙丰.浅谈急性颅脑损伤患者的临床麻醉[J].中国医药指南,2011,9(19):187-188.
[4]王明盛.颅内外动脉吻合治疗缺血型脑血管病25例临床分析[J].中国实用神经疾病杂志,2012,15(12):17-19.
[5]Khoo K,Lepas B.Summary of evidence-based guideline:Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease:report of the Guideline Development Subcommittee of the American Academy of Neurology[J].Neurology,2014,82(1):95.
[6]杨天涛.急性颅脑损伤患者的麻醉处理[J].中西医结合心脑血管病杂志,2009,7(12):1505-1506.
[7]Jeffree RL,Stoodley MA.STA-MCA bypass for symptomatic carotid occlusion and haemodynamic impairment[J].J Clin Neurosci,2009,16(2):226-235.
[8]裘伟琪,乐海伟.急性颅脑损伤手术的麻醉处理[J].浙江创伤外科,2010,15(2):246-247.
[9]马占君.急性颅脑损伤临床麻醉处理分析[J].医学新知杂志,2010,20(4):371-372.
[10]白先武.120例缺血性脑血管病临床分析与治疗探讨[J].中国现代药物应用,2010,4(8):71-72.
[11]罗永温.急性颅脑损伤临床麻醉处理分析[J].吉林医学,2011,32(8):3742-3743.
[12]Baron J,Yamauchi H,Fujioka M,et al.Selective neuronal loss in ischemic stroke and cerebrovascular disease[J].J Cereb Blood Flow Metab,2014,34(1):2-18.
[13]段立杰.急性颅脑损伤麻醉处理78例分析[J].中国误诊学杂志,2010,14(4):908-909.
[14]裴远宾.瑞芬太尼在急性颅脑损伤手术中的麻醉效果分析[J].医药论坛杂志,2011,32(11):148-149.
[15]徐彦华,孙雪莲,汪丽静,等.缺血性脑血管病临床60例治疗体会[J].中国现代药物应用,2013,7(19):72-73.