摘要
【目的】探讨急性颅脑外伤患者术中过度通气对脑氧供需平衡及血清神经元特异性烯醇化酶（NSE）的影响。【方法】45例急性颅脑外伤患者，手术中分别于正常通气（PETCO2 5．0kPa）、轻度（PETCO2 5．0～4．0kPa）、中度（PETCO2 3．5kPa）、重度（PETCO2 3．0kPa）过度通气并稳定15min后同步采集颈静脉球部血样行NSE测定及血气分析，监测SivO2并计算DnjvO2.【结果】随着PETCO2的降低，患者血清NSE呈下降趋势，SjvO2下降，DnjvO2增加，在中度过度通气时均在安全范围，但至重度过度通气时，血清NSE显著升高（P〈0．01），已造成部分患者脑细胞缺血性损伤。[结论】脑外伤术中过度通气可影响脑氧供需平衡，在颅脑手术麻醉中应避免重度过度通气。
[Objective]To explore the effects of hyperventilation on the balance of supply and consumption of cerebral oxygen and serum neuron-specific enolase（NSE） in patients with acute brain trauma undergoing neurosurger y. [Methods] Forty five acute brain trauma patients underwent intravenous general anesthesia and brain surgery. Me chanical ventilation was regulated to maintain PETCO2 at 5.0 kPa（normal ventilation）, 5.0~ 4.0 kPa（slight hyper ventilation）, 3.5 kPa（moderate hyperventilation）and 3.0kPa（severe hyperventilation） during operation. After each level of Pv.TCO2 was maintained for 15rain, the radial arterial blood samples and jugular bulb blood samples were taken simultaneously for the nleasurement of NSE and blood gas analysis. SjvO2 was monitored and Dn-jvO2 was calculated. [Results] With the decrease of PETCO2 , serum NSE and SjvO2 declined, and DnjvO2 increased, but which were still within normal limits during moderate hyperventilation. During severe hyperventilation, serum NSE increased signifi- cantly（ P 〈0.01）, which resulted in ischemic injury of brain cells in some patients. [Conclusion] Intraoperative hyperventilation can affect the balance of supply and consumption of cerebral oxygen. Severe hyperventilation should be avoided during anesthesia for brain surgery.
出处
《医学临床研究》
CAS
2010年第6期1021-1023,共3页
Journal of Clinical Research
关键词
急性病
脑损伤
通气过度
氧
磷酸丙酮酸水合酶
acute disease
brain injeries
hyperventilation
oxygen
phosphopyruvate hydratase
