【摘要】 目的 为探讨动脉瘤术中进行脑组织氧代谢监测的临床意义。方法 20例颅内动脉瘤夹闭术中,对载瘤动脉暂时阻断,并对被阻断动脉供血区脑组织持续进行氧代谢监测,比较阻断前后P_btO₂、P_btCO₂和pH的变化。结果 载瘤动脉阻断后,P_btO₂从阻断前（22±3）mmHg下降到（14±2）mmHg（P<0.01）,P_btCO₂从（46±2）mmHg升高到（54±3）mmHg（P<0.01）,pH从7.10±0.03下降到7.02±0.02（P<0.01）;被阻断动脉供血区出现脑梗塞者3例。结论 脑组织氧代谢监测可及时准确地发现载瘤动脉阻断后而引起的脑组织缺血缺氧,并有助于术者调整阻断时间,从而防止阻断动脉造成医源性脑缺血损害。更多还原

【Abstract】 Objective To evaluate the clinical significance of monitoring the oxygenic metabolism in the cerebral tissue during the surgery for aneurysms. Methods Twenty patients with intracranial aneurysms were operated on with the aid of temporary occlusion of the parental arteries. The partial pressures of oxygen (PbtO2) carbon dioxide(PbtCO2)and pH in the cerebral tissue fed by the parental arteries were continuously monitored by Neurotrend-7 before and after the temporary occlusion of the parental arteries. Results The mean values of the PbtO2 (14mmHg±2mmHg), PbtCO2 (54mmHg±3mmHg) and pH (7.10±0.02) after the occlusion were significantly different from those of PbtO2 (22mmHg±3mmHg), PbtCO2 (46mmHg±2mmHg) and pH (7.02±0.02) before the occlusion (P<0.01). The infraction of the corresponding cerebral areas undergoing temporary arterial occlusion occurred in 3 patients. Conclusion The Anoixc and ischemic cerebral injury caused by the temporary occlusion of the parental arteries can be detected in good time by continuously monitoring the oxygenic metabolism in the corresponding cerebral areas during the surgery in the patients with intracranial aneurysms. Therefore the monitoring cerebral oxygenic metabolism enable the neurosurgeon to alter the surgical strategy early after occlusion of the parental arteries to prevent iatrogenic ischemia brain damage.更多还原