广西医学

目的探讨硝酸甘油联合艾司洛尔控制性降压对后路腰椎cage植入椎体间融合术患者脑功能的影响。方法将40例行后路腰椎cage植入椎体间融合术的患者随机分为观察组和对照组，每组20例。两组患者均接受标准全身麻醉流程。对于观察组，手术开始后采用硝酸甘油联合艾司洛尔进行控制性降压，将平均动脉压（MAP）降至基础值的70％，此后根据术中患者的心率和血压情况调整硝酸甘油剂量，至冲洗手术切口时停用硝酸甘油及艾司洛尔，恢复血压在基础值的±20%以内。对照组则不进行控制性降压处理，且手术期间维持血压在基础血压的±20%以内。比较两组患者一般临床观察指标及相关药物使用情况，不同时间点的心率、MAP、局部脑氧饱和度（rScO2）、脑电双频指数（BIS）、呼气末二氧化碳分压（PetCO2），术前、术毕即刻及术后24 h血清S100β蛋白和神经元特异性烯醇化酶（NSE）水平，以及术前、术后1 d、术后3 d、术后5 d的简易智力状况检查（MMSE）量表评分。结果观察组术中出血量少于对照组（P<0.05），其余一般临床观察指标和相关药物使用情况差异无统计学意义（P>0.05）。两组患者的心率和MAP整体上均呈随时间先下降再上升的变化趋势，观察组在控制性降压过程中的MAP低于对照组（P<0.05），但两组患者各时间点的心率差异无统计学意义（P>0.05）。两组患者的BIS均有随时间先下降再上升的趋势，PetCO2和rScO2整体上呈上升-下降-上升的变化趋势，但两组患者各时间点的BIS、PetCO2、rScO2之间的差异无统计学意义（P>0.05）。两组患者的血清NSE、S100β蛋白水平及MMSE量表评分均无随时间变化的趋势，且两组间上述指标差异无统计学意义（P>0.05）。结论在后路腰椎cage植入椎体间融合术中应用硝酸甘油联合艾司洛尔进行控制性降压，可减少术中出血量，对围术期BIS、PetCO2、rScO2的影响与未行控制性降压者相似，且对围手术期血清S100β蛋白及NSE水平、MMSE量表评分无明显影响。

Objective To investigate the effect of nitroglycerin combined with esmolol controlled hypotension on cerebral function in patients undergoing posterior lumbar interbody fusion with cage implantation. Methods Forty patients received posterior lumbar interbody fusion with cage implantation were randomly assigned to observation group or control group, with 20 cases in each group. Both groups received standard general anesthesia procedure. The observation group received nitroglycerin combined with esmolol controlled hypotension after the start of surgery to reduce mean arterial pressure (MAP) to 70% of the baseline value. After then, the nitroglycerin dosage was subsequently adjusted according to intraoperative heart rate and blood pressure. Nitroglycerin and esmolol were stopped and blood pressure was restored within ±20% of the baseline when the incision was flushed. The control group received no treatment for controlled hypotension, and the blood pressure was maintained within ±20% of the baseline during the operation. The general clinical observation indices and the usage of relevant drugs, as well as heart rate, MAP, regional cerebral oxygen saturation (rScO2), bispectral index (BIS), and end⁃tidal carbon dioxide partial pressure (PetCO2) at different time points; furthermore, the levels of serum S100β protein and neuron‑specific enolase (NSE) before surgery, immediately after surgery, and 24 hours postoperatively, as well as Mini‑Mental State Examination (MMSE) score before surgery, and 1, 3, and 5 days after surgery, were all compared between patients of the two groups. Results The observation group exhibited less intraoperative bleeding volume as compared with the control group (P<0.05), whereas there was no statistically significant difference in the remaining general clinical observation indices and the usage of relevant drugs between the two groups (P>0.05). The heart rate and MAP of both groups interpreted a trend of first decreasing and then increasing over time, and the observation group yielded lower MAP during the process of controlled hypotension as compared with the control group (P<0.05), but there was no statistically significant difference in the heart rate between the two groups at various time points (P>0.05). The BIS of the two groups decreased firstly and then increased with time, whereas PetCO2 and rScO2 overall exhibited a trend of first increasing followed by decreasing and then increasing, but there was no statistically significant difference in BIS, PetCO2 and rScO2 between the two groups at various time points (P>0.05). The levels of serum NSE, S100β protein and MMSE score in the two groups did not change with time, and there was no statistically significant difference between the two groups (P>0.05). Conclusion Nitroglycerin combined with esmolol controlled hypotension can reduce intraoperative bleeding volume in patients undergoing posterior lumbar interbody fusion with cage implantation, and its effect on perioperative BIS, PetCO2, rScO2 is similar to non⁃controlled hypotension, exerting no significant effect on perioperative serum S100β protein and NSE levels, and MMSE score.

ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref
ref