摘要
目的探讨颅内静脉窦血栓形成(CVST)患者血管内治疗的麻醉管理方法。方法回顾性分析首都医科大学宣武医院介入诊断治疗科2009年1月—2011年12月血管内治疗(包括溶栓、支架置入、碎栓)CVST患者的麻醉资料,纳入接受喉罩全身麻醉(18例)和气管插管全身麻醉(26例)的患者共44例,对危险因素、术中监测数据、镇痛药物的使用、并发症等资料进行比较分析。结果 44例患者术毕拔管30例,其中气管插管组拔管率为50.0%(13/26),低于喉罩组的94.4%(17/18),两组比较差异有统计学意义,χ2=9.675,P<0.01。①对昏迷(2例)和脑出血(6例)的8例患者,均采用气管插管麻醉。伴有多发性静脉窦血栓危险因素的患者采用气管插管的比率为76.0%(19/25),高于采用喉罩全身麻醉的比率(24.0%,6/25),差异有统计学意义(P<0.01)。伴有局灶症状的患者采用喉罩全身麻醉的比率为69.2%(18/26),高于采用气管插管麻醉的30.8%(8/26),差异有统计学意义(P<0.05)。②麻醉诱导后,气管插管组的平均动脉压(MAP)降低,术中升高,与患者的基础水平比较,差异有统计学意义(P<0.05);喉罩组MAP各时点两两比较的差异无统计学意义(P=0.077)。两组各阶段的呼气末二氧化碳分压差异无统计学意义,血氧饱和度在拔除气管插管后均出现下降,与拔管前比较,差异有统计学意义(P<0.05)。气管插管组麻醉后的体温与基础体温比较,差异有统计学意义(P<0.05),喉罩组体温有下降趋势,但与诱导前比较差异无统计学意义(P=0.068)。③气管插管组患者的镇痛药芬太尼用量[(3.49±0.66)μg/kg]高于喉罩组[(2.53±0.50)μg/kg],差异有统计学意义(P=0.038),瑞芬太尼的用量两组差异无统计学意义(P=0.718)。④气管插管组无肺栓塞和颅内出血并发症,喉罩组有颅内出血1例,咽痛2例,体动反应1例。结论在CVST患者接受血管内治疗的麻醉管理中,对伴有高危因素的CVST患者宜选择气管插管全身麻醉;需要密切监测生命体征以及完善的镇痛,维持血压在基础水平,维持脑灌注压。
Objective To investigate anesthesia management characteristics of endovascular treatment in patients with cerebral venous sinus thrombosis （CVST）. Methods The anesthesia information of endovas-cular treatment （including thronbolysis, stenting and thrombectomy） in 44 patients with CVST at the Depart-ment of Vascular Uhrasonography, Beijing Xuanwu Hospital, Capital Medical University from January 2009 to December 2011 was analyzed retrospectively. The patients using laryngeal mask general anesthesia （n = 26） and endotracheal intubation general anesthesia （n = 18） were enrolled. The data such as risk factors, intraopera-tire monitoring, analgesic drug used and complications were compared and analyzed. Results Thirty of the 44 patients underwent endotracheal extubation after procedure, the extubation rate in the tracheal intuba-tion group was 50.0% （13/26） ,it was lower than 94.4% （17/18） in the laryngeal mask general anesthe-sia group. There was significant difference between the 2 groups （X^2 -9. 675, P 〈 0.01 ）. ①Eight patients with coma （ n = 2） and intracranial hemorrhage （ n = 6） were underwent anesthesia with tracheal intubation. The tracheal intubation rate was 76.0% （ 19/25 ） in patients with the risk factors for multiple venous sinus thrombosis, and it was higher than 24.0% （6/25） in those with laryngeal mask general anesthesia. There was significant difference （ P 〈 0.01 ）. The laryngeal mask general anesthesia rate in patients with focal symptoms was 69.2% （ 18/26）, and it was higher than 30.8% （8/26） in those with endotracheal intuba- tion anesthesia. There was significant difference （P 〈 0.05 ）. ②The mean arterial pressure （MAP） in the tracheal intubation group decreased after induction, and it increased during the procedure. Compared to the basic level, there was significant difference （P 〈 0.05）. The MAP group at various stages did not show significant differences in the laryngeal mask anesthesia group（P = 0. 077）. There was no significant differ-ence in end-tidal carbon dioxide partial pressure at various stages between the 2 groups. Oxygen saturation decreased after tracheal extubation. As compared to before tracheal extubation, there was significant differ-ence （ P 〈 0.05 ）. There was significant difference in the tracheal intubation group between the body tem-perature after anesthesia and the basal body temperature （P 〈 0.05 ）. The body temperature had a tendency of decline in the laryngeal mask general anesthesia group, but there was no significant difference as com-pared to before induction （P = 0. 068）. ③The dosage of fentanyl in the patients of the tracheal intubation group was higher than that in the laryngeal mask general anesthesia group （ P = 0. 038 ）. There was no sig- nificant difference in the dosage of remifentanil between the 2 groups （ P = 0.718 ）. There was no sig- nificant difference in the amount of autologous blood transfusion between the 2 groups （ P = 0. 052）. ④There were no pulmonary embolism and intracranial bleeding complications in the tracheal intubation group. One patient had intracranial hemorrhage, 2 had pharyngalgia and 2 had body movement re-sponse in the laryngeal mask general anesthesia group. Conclusion During the anesthesia, the pa-tients with CVST received endovascular treatment. The CVST patients with high risk factors should choose general anesthesia and endotracheal intubation. Close monitoring of vital signs and perfect analgesia, main-taining blood pressure at a basic level, and maintaining cerebral perfusion pressure are needed.
出处
《中国脑血管病杂志》
CAS
2012年第12期634-638,共5页
Chinese Journal of Cerebrovascular Diseases
基金
"十一五"国家科技支撑计划项目(2011BAI08B07)
关键词
窦血栓形成
颅内
溶栓
治疗性
麻醉
全身
插管法
气管内
喉面罩
Sinus thrombosis, intracranial
Thrombolysis, therapeutic
Anesthesia, general
Intubation, intratracheal
Laryngeal mask
