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目的:评价术前静脉注射磷酸肌酸钠(CP)用于颅内动脉瘤栓塞术麻醉的临床价值。方法:符合ASA分级Ⅰ～Ⅱ,年龄17～63岁,拟行颅内介入治疗大脑前动脉瘤患者40例,随机分为2组:磷酸肌酸钠组(Ⅰ组,n=20)和对照组(Ⅱ组,n=20)。Ⅰ组,术前60min静脉注射CP60mg·kg-1;Ⅱ组,静脉注射等量生理盐水。2组分别于治疗前(T0)、手术开始(T1)、手术30min(T2)、手术结束(T3)、清醒即刻(T4),记录MAP、HR、CVP。于治疗前、后测定动脉血氧饱和度(CaO2)、颈内静脉血氧饱和度(SjvO2)和动静脉乳酸含量,并计算出动脉颈内静脉血氧含量差(DA-JVO2)、脑氧摄取率(CERO2=DA-JVO2/CaO2)和动脉颈内静脉血乳酸含量差(DA-JVL)。记录术中脑血管痉挛病例,术后麻醉复苏时间及恶心、寒战等不良反应。结果:Ⅰ组患者治疗前后血流动力学较Ⅱ组稳定(P<0.05)。与治疗前比较,Ⅰ组在治疗后SjvO2升高,DA-JVO2和CERO2均有降低(P<0.05)。Ⅰ组DA-JVL在治疗后明显降低(P<0.05)。对照组SjvO2、DA-JVO2、CERO2和DA-JVL虽有一定变化,但差异无统计学意义(P>0.05)。术中,Ⅱ组脑血管痉挛9例(47.4%),明显高于Ⅰ组2例(11.1%),P<0.05。术后,Ⅰ组苏醒时间为(13.5±1.9)min,显著低于对照组的(16.4±3.7)min,P<0.05。结论:术前早期应用CP可稳定血流动力学指标,降低继发性脑血管痉挛发生率,促进术后早期复苏。
Objective: To evaluate the clinical value of preoperative intravenous administration of sodium creatine phosphate (CP) for anesthesia with intracranial aneurysm embolization. Methods: According to ASA classification Ⅰ ~ Ⅱ, aged from 17 to 63, 40 patients with anterior cerebral artery aneurysm were treated with intracranial interventional therapy. They were randomly divided into 2 groups: sodium creatine phosphate group (n = 20) and control group Group (Group II, n = 20). Group Ⅰ, intravenous CP60mg · kg-1 60min before operation; Group Ⅱ, intravenous injection of equal amount of saline. The MAP, HR and CVP were recorded in the two groups before treatment (T0), at the beginning of operation (T1), at 30 min (T2), at the end of operation (T3) and immediately after soberness (T4). Before treatment and after treatment, arterial oxygen saturation (CaO2), internal jugular venous oxygen saturation (SjvO2) and arterial-venous lactic acid content were measured, and arterial blood oxygen content difference (DA-JVO2) The rate of uptake (CERO2 = DA-JVO2 / CaO2) and arterial jugular venous blood lactate content difference (DA-JVL). Records of intracranial cerebral vasospasm cases, postoperative anesthesia recovery time and nausea, chills and other adverse reactions. Results: The hemodynamics of group Ⅰ before and after treatment were more stable than those of group Ⅱ (P <0.05). Compared with those before treatment, SjvO2 in group Ⅰ increased and DA-JVO2 and CERO2 decreased after treatment (P <0.05). DA-JVL in group Ⅰ was significantly lower after treatment (P <0.05). There was no significant difference in SjvO2, DA-JVO2, CERO2 and DA-JVL in the control group (P> 0.05). In operation, 9 cases (47.4%) of group Ⅱ had cerebral vasospasm, which was significantly higher than that of group Ⅰ (2 cases, 11.1%), P <0.05. After operation, the recovery time in group Ⅰ was (13.5 ± 1.9) min, which was significantly lower than that in control group (16.4 ± 3.7) min, P <0.05. Conclusion: The use of CP before operation can stabilize the hemodynamic parameters, reduce the incidence of secondary cerebral vasospasm, and promote the early postoperative recovery.