摘要背景 过度通气作为神经外科手术麻醉中的重要方法,其有效性还缺乏验证.我们在由手术医师评估脑肿胀分级和测定颅内压(ICP)的条件下,选择中度低碳酸血症和正常血液碳酸数值两种情况对接受开颅手术的幕上脑肿瘤患者进行一项双周期随机交叉试验研究.方法 275例幕上脑肿瘤患者随机接受以下治疗程序:一是过度通气(动脉二氧化碳分压,PaCO2=25±2mmHg)继以正常通气(动脉二氧化碳分压,PaCO2=37±2 mm Hg);二是正常通气继以过度通气.通气和呼气末CO2分压保持稳定20分钟.患者随机接受丙泊酚输注或异氟烷吸入麻醉.在每一试验阶段末由不了解治疗程序的手术医师测定ICP,并以4级评定方法评估脑肿胀分级.结果 以通用估计方程模型分析,我们发现过度通气降低了45%脑肿胀加重的风险,P=0.004,95%可信区间为22%～61%,需要治疗患者数为8.过度通气期间ICP均数±标准差为12.3±8.1 mm Hg,低于正常通气时的16.2±9.6 mm Hg.P<0.001.麻醉方式对脑肿胀评估和ICP无影响.结论 对幕上脑肿瘤患者而言,手术中过度通气可改善与ICP降低相关的由手术医师评估的脑肿胀程度.
作者谢珺田[1]Adrian W. Gelb[2]Rosemary A. Craen[3]G. S. Umama-heswara Rao[4]K. R. Madhusudan Reddy[5]Joseph Megyesi[6]Bibek Mohanty[6]Hari H. Dash[7]Kai C. Choi[8]Mathew T.V. Chan学术成果认领
作者单位Department of Anesthesia and Perioperative Care, University of California at San Frandsco, San Francisco, California[1]Department of Anesthesia and Perioperative Medicine, University of West-ern Ontario, Canada[2]Departments of Anesthesia and National Institute of Mental Health and Neurosciences, Bangalore, India[3]Departments of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, India[4]Department of Neurosurgery, University of Western Ontario, Canada[5]Department of Neuroanesthesiology, All India Institute of Medical Sci-ences, Delhi, India[6]Centre for Epidemiology and Biostatistics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region[7]Department of Anaesthesia and Intensive Care, CUHK Brain Tumor Center, The Chinese University of Hong Kong, Prince of Wales Hospi-tal, Hong Kong Special Administrative Region[8]
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