Perioperative cerebral protective effects of small dose norepinephrine combined with goal-directed fluid therapy in patients with cerebral revascularization
Objective To investigate the perioperative cerebral protective effects of small dose norepi-nephrine(NE)combined with goal-directed fluid therapy(GDFT)in the patients with cerebral revasculariza-tion.Methods Forty patients with scheduled superficial temporal artery-middle cerebral artery bypass graft-ing were selected as the study subjects and divided into the small dose NE combined GDFT group(group G)and small dose NE combined conventional fluid therapy group(group C),20 cases in each group.The group G conducted the fluid infusion with the stroke volume variation(SVV)as the goal orientation.The group C re-ceived the volumetric therapy by the traditional infusion regimen.The low-dose of norepinephrine(0.01-0.03 μg·kg-1·min-1)was continuously pumped after induction of anesthesia in both groups.The hemody-namic indexes and cerebral oxygen metabolism related indexes were recorded after anesthetic induction(Tt),immediately after middle cerebral artery occlusion(T2),immediately after vascular bypass perfusion(T3)and at the end of operation(T4),meanwhile,the levels of NSE and S100β was measured.The intraoperastive in-take and output amounts,postoperative complications,hospitalization duration and NIHSS scores at D0,D1,D3 and D7 were recorded.Results There were no statistically significant differences in the blocking time of mid-dle cerebral artery,intraoperative output volume,hospitalization duration,complications occurrence rate,HR at each time point,Da-jvO2 and LacPR between the two groups(P＞0.05).Compared with the group C,the crystal fluid intake volume,colloid fluid intake volume and total infusion volume in the group G were signifi-cantly decreased,MAP and SjvO2 at T4 were increased significantly,CERO2 at T4 was significantly decreased,the levels of S100β protein and NSE at T4 were significantly decreased,the NIHSS score at D7 was significant-ly decreased,and the differences were statistically significant(P＜0.05).Conclusion Simultaneous persistent pump injection of small dose NE in the patients with cerebral revascularization receiving GDFT could reduce intraoperative infusion total volume,stabilize hemodynamics,optimize the cerebral oxygen supply and protect the cerebral function in patients undergoing cerebral revasculopathy.
goal orientation fluid therapynorepinephrinecerebral revascularizationbrain metabolismhaemodynamics index
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维普
