文档介绍：经蝶显微手术治疗鞍上扩展型垂体腺瘤的麻醉
作者: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
摘要: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. ・L-1 ・kg-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(%)在15min内清醒拔管,(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)尚能维持循环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 The data of anesthetic procedure were reviewed in198PASE pa-tients undergoing transsphenoidal was maintained with continuous intravenous infusion of2%procaine ・kg-1 ・min-1 bined %~%isoflurane 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 -rameters of circulation and cerebral oxygenation before and after the infusion of saline into subarachnoid space were mon-itored in15patients under general anesthesia with intra-venous All the patients were stable and smooth during (%)were con-scious and intubation was extracted within15min after the were plications related to (mean)of saline was injected into subarachnoid space,which increased ICP and decreased cerebral perfusion pres-sure(CPP)
heart rate(HR),mean arterial pressure(MAP)and the paramete