经蝶显微手术治疗鞍上扩展型垂体腺瘤的麻醉医学论文.docVIP

经蝶显微手术治疗鞍上扩展型垂体腺瘤的麻醉 ：王强陈绍洋宁晓文熊利泽胡文能胡胜曾祥龙 关键词】垂体腺瘤 关键词：垂体腺瘤;显微外科手术;脑氧平衡 :目的探讨鞍上扩展型垂体腺瘤（PASE）经蝶显微手术麻 醉的特殊性以及术中蛛网膜下腔注水后颅内压（ICP）增高对循环和 脑氧供需平衡的影响.方法回顾性总结198例PASE患者经蝶入路 行肿瘤切除术的麻醉程序.术中持续静脉滴注20mgL-l的普鲁卡因 l.Omgkg-1 min-1或间断辅以5?10mL L-1异氟醚吸入维持麻 醉，通过腰蛛网膜下腔予置一导管注射生理盐水，增高ICP使鞍上 瘤体进入手术野以利切除，并监测了 15例患者注水前后循环和脑氧 供需平衡的变化.结果麻醉过程平稳，术后179例（90.1%）在 15min内清醒拔管，无严重麻醉并发症.术中向蛛网膜下腔注射生理 盐水（平均44mL）,虽然引起ICP明显升高、CPP显著降低，但心 率、平均动脉压和反映脑氧供需平衡的各参数均未变化.结论PASE 经蝶入路显微手术全麻期间，在ICP监测下经腰蛛网膜下腔注生理 盐水（35?70mL）尚能维持循坏稳定和脑氧供需平衡. Keywords: pituitary adenoma;microsurgery;cerebral oxy-genation Abstract:AIM To probe the characteristics of anesthet-icprocedure for the removal of pituitary adenomas with suprasellar extensions (PASE) and effect of intracranial pres-sure (ICP) elevation in situ by infusion of saline into sub-arachnoid space during the procedure on circulation and cere-bral oxygen supply/consumption balance.METHODS The data of anesthetic procedure were reviewed inl98PASE pa-tients undergoing transsphenoidal microsurgery.Anesthesia was maintained with continuous intravenous infusion of2%procaine atl.Omg kg-1 min-1 or combined with0.5%~ 1.0%isoflurane inhalation.Saline was slowly injected through a catheter inserted into the lumbar subarachnoid space to increase the ICP and force the suprasellar tumor into the operative field for aiding the removal of the tumor.Pa-rameters of circulation and cerebral oxygenation before and after the infusion of saline into subarachnoid space were mon-itored in 15patients under general anesthesia with intra-venous procaine.RESULTS All the patients were stable and smooth during anesthesia. 179patients ( 90.1% ) were con-scious and intubation was extracted within 15min after the surgery.There were no complications related to anesthesia.44mL ( mean ) of saline was injected into subarachnoid space, which increased ICP and decreased cerebral perfusion pres-sure (CPP) significantly.But heart rate (HR), mean arterial pressure (MAP) and the parameters of cerebral oxygen sup-ply