国际麻醉学与复苏杂志   2019, Issue (1): 0-0
    
烟雾病血运重建期间颞浅动脉桥抗痉挛处理的 实验研究
李渊, 胡强夫, 聂晓红, 屈罡升, 蒋超, 郭佩垒, 闵娜, 闫瑞琪1()
1.郑州大学第五附属医院
An experimental study on antispasmodic treatment of superficial temporal artery graft during revascularization for moyamoya disease
 全文:
摘要:

目的 比较硝酸甘油、尼莫地平、地尔硫卓对烟雾病颞浅动脉?蛳大脑中动脉旁路移植术(superficial temporal artery-middle cerebral artery bypass, STA-MAC)中桥血管抗痉挛的效果。 方法 择期行STA-MAC的烟雾病患者65例,按随机数字表法分为3组:硝酸甘油组(Ⅰ组,22例)、尼莫地平组(Ⅱ组,22例)、地尔硫卓组(Ⅲ组,21例)。3组患者入手术室到出手术室以0.3~0.5 μg·kg-1·min-1持续泵入药物。选取旁路移植前(T1)、清醒拔管后即刻(T2)及旁路移植术后3 d(T3)为观察时点,使用血管超声测量3组患者颞浅动脉(superficial temporal artery, STA)主干血流的最大速度(maximum velocity, Vmax)、最小速度(minimum velocity, Vmin)、平均速度(mean velocity, Vm)、阻力指数(resistance index, RI)、内径(inside diameter, ID),并记录3个时点的MAP、心率、CVP,通过分析桥血管血流状态评估3种药物对STA血管桥的舒张作用。 结果 与T1比较,T3时3组患者Vmax、Vmin、Vm、ID 增大,RI变小,差异有统计学意义(P<0.05)。与Ⅰ组比较,T2时Ⅱ组患者Vmax、Vmin、Vm增大,RI减小,Ⅲ组患者Vmin增大,RI减小,差异有统计学意义(P<0.05);Ⅱ组与Ⅲ组比较,差异无统计学意义(P>0.05)。 结论 尼莫地平与地尔硫卓对STA?蛳MAC桥血管的舒张、抗痉挛作用优于硝酸甘油。

关键词: 烟雾病; 颞浅动脉?蛳大脑中动脉旁路移植术; 硝酸甘油; 尼莫地平; 地尔硫卓
Abstract:

Objective To compare the antispasmodic effects of nitroglycerin, nimodipine and diltiazem on the superficial temporal artery(STA) during the superficial temporal artery-middle cerebral artery bypass (STA-MAC). Methods A total of sixty-five patients with moyamoya disease who underwent STA-MAC were divided into three groups according to random number table. GroupⅠ was administered nitroglycerin (n=22), groupⅡ was given nimodipine (n=22), and group Ⅲ was given diltiazem (n=21). The patients were continuously pumped with 0.3-0.5 μg·kg-1·min-1 during the surgery. Then, the maximum flow velocity (Vmax), the minimum flow velocity (Vmin), the mean flow velocity (Vm), resistance index (RI), and inside diameter (ID) of the STA before graft (T1), immediately after extubation (T2) and three days after operation (T3) were recorded using vascular ultrasound. Meanwhile, the mean arterial pressure (MAP), heart rate and central venous pressure (CVP) were recorded. Results The three groups showed remarkably increased Vmax, Vmin, and Vm, and ID and decreased RI at T3 compared with those at T1 (P<0.05). Compared with group Ⅰat T2, groupⅡdemonstrated marked increases in Vmax, Vmin and Vm and decreases in RI, while group Ⅲ showed obviously increased Vmin and decreased RI (P<0.05). There was no significant difference between groupⅡand Ⅲ (P>0.05).  Conclusions Nimodipine and diltiazem are superior to nitroglycerin in the diastolic and antispasmodic effects on STA-MAC.

Key words: Moyamoya disease; Superficial temporal artery?蛳middle cerebral artery bypass; Nitroglycerin; Nimodipine; Diltiazem