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目的 测定颅内动脉瘤夹闭术围手术期血S1 0 0B蛋白含量 ,研究异氟醚麻醉复合持续输注尼莫地平的安全性。方法 择期颅内动脉瘤夹闭术患者 30例 ,随机分为两组 :异氟醚麻醉组 (ISO组 )和尼莫地平组 (NIMO组 ) ,每组 1 5例。ISO组术中吸入 1个最低肺泡有效浓度 (MAC)的异氟醚维持麻醉。NIMO组在诱导后输注尼莫地平 2 0 μg·kg-1 ·h-1 直至手术结束 ,同时吸入 1MAC异氟醚维持麻醉。分别于不同时间测定循环指标及取血测定S1 0 0B蛋白含量。结果 NIMO组输注尼莫地平 2 0 μg·kg-1 ·h-1 后血压降低幅度在安全范围内 ,心率无显著变化 ;外周血管阻力下降 ,而心输出量、心肌收缩力增加。ISO组在动脉瘤夹闭前后血S1 0 0B蛋白浓度有显著升高 (F =3.1 36 ,P =0 .0 1 4 ) ,而NIMO组S1 0 0B蛋白浓度无明显差异。结论 在颅内动脉瘤夹闭术中输注尼莫地平对血流动力学影响在安全范围内 ,该剂量可减轻动脉瘤夹闭后载瘤动脉血管痉挛的程度
Objective To determine the serum level of S100B protein during intracranial aneurysm clipping and to study the safety of isoflurane combined with sustained nimodipine infusion. Methods Thirty patients with elective intracranial aneurysm clipping were randomly divided into two groups: Isoflurane anesthesia group (ISO group) and Nimodipine group (NIMO group), 15 cases in each group. ISO group intraoperative inhalation of a minimum effective concentration of alveolar concentration (MAC) of isoflurane to maintain anesthesia. NIMO group was injected with nimodipine 20 μg · kg-1 · h-1 until the end of surgery after inhalation, while inhalation of 1 MAC isoflurane anesthesia. Circulation index and blood sampling were measured at different times to determine S100B protein content. Results After NIMO infusion, nimodipine (20 μg · kg-1 · h-1) showed no significant change in heart rate, reduced peripheral blood pressure, and decreased cardiac output and myocardial contractility. The concentration of S100B protein in the ISO group was significantly increased before and after aneurysm occlusion (F = 3.136, P = 0.014), while there was no significant difference in the concentration of S100B protein in the NIMO group. Conclusions Infusion of nimodipine in intracranial aneurysm clipping surgery has a hemodynamic impact within a safe range that can reduce the extent of aneurysm vasospasm following aneurysm clipping