肺泡复张手法对幕上肿瘤切除术患者脑膨出、脑肿胀和平均动脉压的影响：一项随机交叉研究。

Effects of an alveolar recruitment maneuver on subdural pressure, brain swelling, and mean arterial pressure in patients undergoing supratentorial tumour resection: a randomized crossover study.

机构信息

Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Room 2449 JPP 899 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.

Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.

出版信息

Can J Anaesth. 2017 Jun;64(6):626-633. doi: 10.1007/s12630-017-0863-7. Epub 2017 Mar 24.

DOI:10.1007/s12630-017-0863-7

PMID:28342045

Abstract

PURPOSE

Although recruitment maneuvers have been advocated as part of a lung protective ventilation strategy, their effects on cerebral physiology during elective neurosurgery are unknown. Our objectives were to determine the effects of an alveolar recruitment maneuver on subdural pressure (SDP), brain relaxation score (BRS), and cerebral perfusion pressure among patients undergoing supratentorial tumour resection.

METHODS

In this prospective crossover study, patients scheduled for resection of a supratentorial brain tumour were randomized to undergo either a recruitment maneuver (30 cm of water for 30 sec) or a "sham" maneuver (5 cm of water for 30 sec), followed by the alternative intervention after a 90-sec equilibration period. Subdural pressure was measured through a dural perforation following opening of the cranium. Subdural pressure and mean arterial pressure (MAP) were recorded continuously. The blinded neurosurgeon provided a BRS at baseline and at the end of each intervention. During each treatment, the changes in SDP, BRS, and MAP were compared.

RESULTS

Twenty-one patients underwent the study procedure. The increase in SDP was higher during the recruitment maneuver than during the sham maneuver (difference, 3.9 mmHg; 95% confidence interval [CI], 2.2 to 5.6; P < 0.001). Mean arterial pressure decreased further in the recruitment maneuver than in the sham maneuver (difference, -9.0 mmHg; 95% CI, -12.5 to -5.6; P < 0.001). Cerebral perfusion pressure decreased 14 mmHg (95% CI, 4 to 24) during the recruitment maneuver. The BRS did not change with either maneuver.

CONCLUSION

Our results suggest that recruitment maneuvers increase subdural pressure and reduce cerebral perfusion pressure, although the clinical importance of these findings is thus far unknown. This trial was registered with ClinicalTrials.gov, NCT02093117.

摘要

目的

尽管在肺保护性通气策略中提倡使用复张手法，但它们对择期神经外科手术期间的脑生理的影响尚不清楚。我们的目的是确定肺泡复张手法对接受幕上肿瘤切除术的患者的硬膜下压力（SDP）、脑弛豫评分（BRS）和脑灌注压的影响。

方法

在这项前瞻性交叉研究中，计划进行幕上脑肿瘤切除术的患者被随机分为复张组（30 cm 水 30 秒）或“假”组（5 cm 水 30 秒），然后在 90 秒平衡期后进行另一种干预。在打开颅骨后通过硬脑膜穿孔测量硬膜下压力。连续记录硬膜下压力和平均动脉压（MAP）。盲法神经外科医生在基线和每次干预结束时提供 BRS。在每次治疗期间，比较 SDP、BRS 和 MAP 的变化。

结果

21 例患者完成了研究程序。与“假”组相比，复张组的 SDP 升高更高（差值为 3.9 mmHg；95%置信区间 [CI]，2.2 至 5.6；P < 0.001）。与“假”组相比，复张组的平均动脉压进一步下降（差值为-9.0 mmHg；95% CI，-12.5 至-5.6；P < 0.001）。复张组脑灌注压下降 14 mmHg（95% CI，4 至 24）。两种手法均未改变 BRS。