摘要
目的探讨磷酸肌酸钠在老年患者神经外科控制性降压手术中的心肌保护作用。方法选取2014年8月—2015年8月在上海交通大学医学院附属新华医院因面肌抽搐需接受面神经微血管减压术(MVD)治疗的老年患者200例,按照随机数字表法将患者分为观察组和对照组,各100例。观察组术中给予磷酸肌酸钠(杜玛)2g溶于乳酸钠林格液500ml中,并在术中1h静脉滴注完毕,对照组静脉滴注乳酸钠林格液500ml。手术过程中使用七氟烷和瑞芬太尼0.1~0.3μg·kg-1·min-1维持麻醉。术中采用七氟烷复合瑞芬太尼进行控制性降压,直至降至基础血压的70%。观察并记录两组患者的围术期血压、血清心肌酶谱及神经损伤相关指标水平。结果插管前两组患者收缩压及舒张压比较,差异无统计学意义(P>0.05);拔管后1h观察组患者收缩压及舒张压均低于对照组,差异有统计学意义(P<0.05)。插管前两组患者血清乳酸脱氢酶和肌酸激酶水平比较,差异无统计学意义(P>0.05);拔管后1h及6h观察组患者血清乳酸脱氢酶和肌酸激酶水平均低于对照组,差异有统计学意义(P<0.05)。两组患者术中及术后6h的血清NSE、Aβ、S100β水平比较,差异无统计学意义(P>0.05)。结论磷酸肌酸钠应用在老年患者神经外科控制性降压手术中具有心肌保护作用。
Objective To discuss the myocardial protective effect of creatine phosphate sodium in elderly patients with controlling hypotension surgery in neurosurgery. Methods A total of 200 elderly prosopospasm patients undergoing microvascular decompression of the facial nerve( MVD) were selected in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from August 2014 to August 2015. They were divided into control group and observation group by random number table,100 cases in each group. In the observation group,creatine phosphate sodium( Du Ma) 2g dissolved in sodium lactate Ringer’s solution 500 ml,and within 1 hour intravenous drip during the operation. While the control group intravenous drip lactated Ringer’s solution 500 ml. In both groups,anesthesia was induced with sevoflurane and remifentanil 0. 1-0. 3μg·kg-1·min-1during the operation. Sevoflurane combined with remifentanil were used to control blood pressure,until fall to the 70%of basal blood pressure. Perioperative blood pressure,myocardial enzymes and related indexes of neural injury level between the two groups were observed and recorded. Results Before intubation systolic blood pressure and diastolic blood pressure between the two groups showed no significant differences( P > 0. 05). 1h after extubation systolic blood pressure and diastolic blood pressure of observation group were lower than those of control group( P < 0. 05). Before intubation lactic dehydrogenase and creatine jubase between the two groups showed no significant differences( P > 0. 05); 1h and 6h after extubation lactic dehydrogenase and creatine jubase levels of observation group were lower than control group( P < 0. 05). Intraoperative and postoperative 6h serum NSE,Aβ,S100β levels between the two groups showed no significant differences( P > 0. 05). Conclusion There is myocardial protective effect of creatine phosphate sodium applied with controlled hypotension in elderly patients in the department of neurosurgery.
出处
《临床合理用药杂志》
2016年第33期16-18,共3页
Chinese Journal of Clinical Rational Drug Use
关键词
神经外科手术
磷酸肌酸钠
Neurosurgical procedures
Creatine phosphate sodium
