[1]袁鹏,雍浩川,王佳,等.多功能经颅骨颅内穿刺针持续颅内压监测指导颅脑创伤手术丙泊酚麻醉用量[J].第三军医大学学报,2018,40(01):82-85.
 YUAN Peng,YONG Haochuan,WANG Jia,et al.Intracranial pressure monitoring guides the dose of propofol in anesthesia for craniocerebral trauma patients[J].J Third Mil Med Univ,2018,40(01):82-85.
点击复制

多功能经颅骨颅内穿刺针持续颅内压监测指导颅脑创伤手术丙泊酚麻醉用量(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第01期
页码:
82-85
栏目:
临床医学
出版日期:
2018-01-15

文章信息/Info

Title:
Intracranial pressure monitoring guides the dose of propofol in anesthesia for craniocerebral trauma patients
作者:
袁鹏雍浩川王佳唐彦明邹胜伟陈菲赫凌峰王恩琴陶国才
重庆,重庆市急救医疗中心神经外科;吉林省吉林市中西医结合医院麻醉科;第三军医大学西南医院麻醉科
Author(s):
YUAN Peng YONG Haochuan WANG Jia TANG Yanming ZOU Shengwei CHEN Fei HE Linfeng WANG Enqin TAO Guocai

Department of Neurosurgery, Emergency Medical Center of Chongqing, Chongqing, 400014; Department of Anesthesiology, Jilin Provincial Hospital of Traditional Chinese and Western Medicine, Jilin, Jilin Province, 132001; Department of Anesthesiology, Southwest Hospital, Third Military Medical University, 400038, China

关键词:
丙泊酚颅脑创伤诱导时间颅内压脑灌注压
Keywords:
propofol craniocerebral trauma induction time intracranial pressure cerebral perfusion pressure
分类号:
R612; R614.2; R971.2
文献标志码:
A
摘要:

目的     探讨以自行设计的“多功能经颅骨颅内穿刺针(专利号:ZL 2008 2 0100454.6)”持续颅内压监测,指导颅脑创伤手术丙泊酚全身麻醉的临床效果。方法    采用前瞻性随机对照研究设计,筛选重庆市急救中心2013年5月至2016年8月68例颅脑创伤手术患者。其中男性37例,女性31例,年龄(46.3±25.8)岁,体质量(63.7±5.6)kg。按随机数字表法分为常规组和试验组(n=34),根据动态监测脑灌注压(cerebral perfusion pressure,CPP)和颅内压(intracranial pressure,ICP)以调整丙泊酚使用。术前利用多功能经颅骨颅内穿刺针行快速颅内压监测颅内压(ICP)、脑灌注压(CPP);比较两组患者麻醉前(T0)、诱导后(T1)、手术1 h(T2)、手术2 h(T3)、手术结束前10 min(T4)患者SBP、DBP、MAP、ICP、CPP的变化。结果    在麻醉诱导前两组SBP、DBP、MAP、ICP、CPP指数均无明显差异(P>0.05);在T2和T3,常规组SBP、DBP、MAP、ICP、CPP下降的程度相对于试验组更加显著(P<0.05)。结论    多功能经颅骨颅内穿刺针在颅脑创伤手术中可有效地监测ICP、CPP改变并能指导丙泊酚的使用,有一定的临床推广价值。

Abstract:

Objective     To guide the dose of propofol for anesthesia in craniocerebral trauma patients by selfdesigned multifunctional transcranial puncture for intracranial pressure monitoring. Methods     A prospective randomized controlled study was designed on 68 patients with craniocerebral trauma. They were randomly divided into the conventional group and the experimental group (n=34), with cerebral perfusion pressure (CPP) and intracranial pressure (ICP) to guide the dose of propofol before operation. The changes of ICP, CPP, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) before anesthesia (T0), in induction (T1), 1 h after operation (T2), 2 h after operation (T3), and 10 min before the end of surgery (T4) were measured and compared between the 2 groups. Results     There were no significant differences in SBP, DBP, MAP, ICP and CPP between the 2 groups before anesthesia induction (P>0.05). At T2 and T3, SBP, DBP, MAP, ICP and CPP were declined more significantly in the conventional group than the experimental group (P<0.05). Conclusion     Our designed multifunctional transcranial puncture can effectively monitor ICP and CPP and guide the dose of propofol for craniocerebral trauma patients. It is worthy of further clinical promotion.

参考文献/References:

[1]周强,蒋栋毅,陈寒春,等.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.
ZHOU Q, JIANG D Y, CHEN H C, et al. Clinic application of continous intracranial pressure and cerebral perfusion pressure monitoring in the treatment of severe traumatic brain injury[J]. Chin J Mod Opera Sur, 2011, 15(5):  386-388.
[2]MEMNENDELSON A A, GLILLIS 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.
[3]RUSSIAN A I. MEAN ICP, ICP amplitude, mean AP and mean CPP dynamic in changing the position of the head of the bed in patients with severe TBI[J]. Anesteziol Reanimatol, 2012(4):68-72.
[4]BAO Y H, LIANG Y M, GAO G Y, et al. Bilateral decompressive craniectomy for patients with malignant diffuse brain swelling after severe traumatic brain injury: a 37case study[J].  J Neurotrauma, 2010, 27(2):341.
[5]邹志浩,张世忠,张文德等. 无创颅内压监测在早期预警高血压脑出血后血肿扩大中的意义.中华神经外科杂志.2013,29(1): 50-53.
ZOU Z H, ZHANG S Z,ZHAGN W D, et al. Clinical study of noninvasive intracranial pressure earlywarning hematoma enlargement in patients with hypertension intracerebral hemorrhage[J].Chin J Neurosurg, 2013,29(1): 50-53.
[6]GOODCHILD C S, SERRAO J M. Propofol-induced cardiovascular depression: science and art[J]. Bri J Anaesth, 2015, 115(4):641-642.
[7]ABDELGAWAD A F, 石琴芳 Q F S, HALAWA M A, et al. COMPARISON OF CARDIAC OUTPUT AND HEMODYNAMIC RESPONSES OF INTUBATION AMONG DIFFERENT VIDEOLARYNGOSCOPIES IN NORMOTENSIVE AND HYPERTENSIVE PATIENTS[J]. 华中科技大学学报(医学英德文版), 2015, 35(3):432-438.
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 Technol (Med Sci), 2015, 35(3):432-438.
[8]SENER E B,USTUN E,USTUN B, et al. Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: Conventional laryngoscopy versus an intubating laryngeal mask airway[J]. Clinics, 2012, 67(1):49-54.
[9]OGOH S,AINSLIE P N. Regulatory mechanisms of cerebral blood flow during exercise: new concepts.[J]. Exercise & Sport Sci Rev, 2009, 37(3):123-129.
[10]KUNDRA S,MAHENDRU V,GUPTA V, et al. Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage[J]. J Anaesthesiol Clin Pharmacol, 2014, 30(3):328-37.
[11]CHERFAN A J, TAMIM H M, ALJUMAH A, et al. Etomidate and mortality in cirrhotic patients with septic shock[J]. BMC Clinical Pharmacology, 2011, 11(1):22.
[12]ANDRADA J, LIVINGSTON P, LEE B J, et al. Propofol and etomidate depress cortical, thalamic, and reticular formation neurons during anestheticinduced unconsciousness[J]. Anesth Analg, 2012, 114(3):661.
[13]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 Anesthesiol, 2011, 21(2):275-81.

相似文献/References:

[1]高谋,徐如祥,杨志军,等.两种干细胞对颅脑创伤炎症反应调控作用的对比研究[J].第三军医大学学报,2015,37(17):1697.
 Gao Mou,Xu Ruxiang,Yang Zhijun,et al.Comparison on immunomodulatory effects of 2 kinds of transplanted stem cells on inflammation secondary to traumatic brain injury in mice[J].J Third Mil Med Univ,2015,37(01):1697.
[2]刘大维,朱佩芳,周继红,等.颅脑撞击伤后脑脊液、血浆CK-BB活性变化及其意义[J].第三军医大学学报,1997,19(06):0.[doi:10.16016/j.1000-5404.1997.06.031 ]
[3]黎海涛,丁仕义,张恩全,等.颅脑创伤早期CT征象与临床表现的对照分析[J].第三军医大学学报,2001,23(06):0.[doi:10.16016/j.1000-5404.2001.06.044 ]
 LI Hai tao,DING Shi yi,ZHANG En quan,et al.[J].J Third Mil Med Univ,2001,23(01):0.[doi:10.16016/j.1000-5404.2001.06.044 ]

更新日期/Last Update: 2018-01-12