中国脑血管病杂志2012，Vol.9Issue(12)：634-638,5.DOI:10.3969/j.issn.1672-5921.2012.12.005
颅内静脉窦血栓形成血管内治疗的麻醉管理
Anesthesia management of endovascular treatment for cerebral venous sinus thrombosis
摘要
Abstract
Objective To investigate anesthesia management characteristics of endovascular treatment in patients with cerebral venous sinus thrombosis (CVST). Methods The anesthesia information of endovascular treatment (including thrombolysis, stenting and thrombectomy) in 44 patients with CVST at the Department of Vascular Ultrasonography, Beijing Xuanwu Hospital, Capital Medical University from January 2009 to December 2011 was analyzed retrospectively. The patients using laryngeal mask general anesthesia (re =26) and endotracheal intubation general anesthesia (n = 18) were enrolled. The data such as risk factors, intraopera-tive 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 intubation group was 50. 0% (13/26) ,it was lower than 94. 4% (17/18) in the laryngeal mask general anesthesia group. There was significant difference between the 2 groups (x2 =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 intubation 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 difference 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 difference (P<0.05). There was significant difference in the tracheal intubation group between the body temperature 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 compared 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 significant difference in the dosage of remifentanil between the 2 groups (P = 0.718). There was no significant 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 response in the laryngeal mask general anesthesia group. Conclusion During the anesthesia, the patients 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, maintaining blood pressure at a basic level, and maintaining cerebral perfusion pressure are needed.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Key words
Sinus thrombosis, intracranial/ Thrombolysis, therapeutic/ Anesthesia, general/Intubation, intratracheal/ Laryngeal mask引用本文复制引用
刘清海,蔡兵,吉训明,王天龙..颅内静脉窦血栓形成血管内治疗的麻醉管理[J].中国脑血管病杂志,2012,9(12):634-638,5.基金项目
"十一五"国家科技支撑计划项目(2011BAI08B07) （2011BAI08B07）
