控制性降壓對大腦影響的系統評價_《中國循證醫學雜志》

作者：

王宇 , 崔宇 , 劉馨燭 ,  劉斌

四川大學華西醫院麻醉科（成都 610041）;

關鍵詞：

控制性降壓腦神經隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20090018

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目的　通過評價控制性降壓（CH）對腦血流、腦代謝及腦高級神經心理功能的影響，為臨床安全應用提供依據。
方法　計算機檢索MEDLINE（1966～2008）、EMbase（1974～2008）、Cochrane 圖書館（2008年第2期）和中國生物醫學文獻數據庫（CBM，1978～2008）、中國期刊全文數據庫（CNKI，1994～2008），按納入與排除標準收集所有相關臨床隨機對照試驗，在評價其質量及提取數據后，采用RevMan4.2.7軟件進行統計分析。
結果　共納入9個RCT包括295例患者，多數研究方法學質量較低。由于結果指標為重復測量的多個均數間比較，無法進行Meta分析，僅作描述性分析。結果顯示：CH組患者大腦中動脈血流、腦缺氧代謝產物、神經心理測量表評分與對照組相比差異均無統計學意義（P lt;0.05）；但與對照組相比，CH組患者術后腦脊液和血中S100蛋白含量顯著增高（P lt;0.02）。
結論　控制性降壓不影響腦血流，不出現缺氧腦代謝，不影響神經生理功能，但在顱內動脈瘤夾閉術患者運用異氟醚行CH可能會加重腦損害。由于本系統評價納入研究質量不高，病例數較少，上述結論尚需進一步設計嚴謹的大樣本隨機對照研究加以驗證。

引用本文： 王宇,崔宇,劉馨燭,劉斌. 控制性降壓對大腦影響的系統評價. 中國循證醫學雜志, 2009, 09(1): 88-92. doi: 10.7507/1672-2531.20090018 復制

1.	王婷. 血液稀釋聯合控制性降壓對機體生理的影響. 國外醫學麻醉學與復蘇分冊, 2002, 23(6): 355-357.
2.	Mincheff Ms, Meryman HI. Blood tranfusion, blood storuge, and immunodulation. Immunol Invest, 1995, 24(12): 303.
3.	鄧碩曾. 輸血與血漿代用品. 見: 陳伯鑒, 主編. 臨床藥理學. 第1版. 北京: 人民衛生出版社, 2000. 580-593.
4.	Chen SY, Zhu XL, Zhang YM, et al. Clinical application of intraoperative autologous blood transfusion. Di-si jun yi Daxue Xubao (J Fourth Mil MedUniv), 2001, 22(6): 542-544.
5.	安剛. 管理循環的技術－控制性低血壓. 引進國外醫藥技術與設備, 1999, 5(11): 11.
6.	黃美清. 控制性降壓在臨床麻醉中的應用進展. 華夏醫學, 2002, 15(3): 425-427.
7.	Degoute CS, Ray MJ, Manchon M, et al. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesth, 2001, 48(1): 20-27.
8.	計根林, 張進, 熊東方, 等. 尼卡地平和烏拉地爾經蝶垂體腺瘤術中迅速降壓效果的比較. 第四軍醫大學學報, 2000, 21(9): 1118-1120.
9.	王天龍, 齊淡琴. 尼卡地平在臨床麻醉中的應用. 國外醫學?麻醉學與復蘇分冊, 2000, 21(1): 40-43.
10.	Endoh H, Honda T, Ohashi S, et al. The influence of nicardipin-, nitroglycerin-and prostaglandin El-induced hypotension on cerebral pressure autoreguration in adult patients during propofol-fentanyl anesthesia. Anesth Analg, 2002, 94(1): 169-173.
11.	Endoh H, Honda T, Komura N, et al. The effects of nicardipine on dynamic cerebral auto regulation in patients anesthetized with propofol and fentanyl. Anesth Analg, 2000, 91(3): 642-646.
12.	Sartcaoglu F, Celiker V, Basgul E, et al. The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery. Eur J Anaesthesiol, 2005, 22(2): 157-159.
13.	Suttner SW, Piper SN, Lang K, et al. Cerebral effects and blood sparing efficiency of sodium nitroprusside-induced hypotension alone and in combination with acute normovolaemic haemodilution. Br J Anaesth, 2001, 87(5): 699-705.
14.	Thompson GE, Miller RD, Stevens WC, et al. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology, 1978, 48(2): 91-96.
15.	韓如泉, 李樹人, 王保國, 等. 異氟醚控制性降壓對顱內動脈瘤夾閉術病人腦脊液中S100B蛋白含量的影響. 中華麻醉學雜志, 2004, 24(4): 272-275.
16.	韓如泉, 凌大林, 李樹人, 等. 異氟醚控制性降壓對顱內動脈瘤夾閉術血中S100B含量的影響. 臨床麻醉學雜志, 2004, 20(1): 13-15.
17.	林才珠, 張良成, 楊錫馨, 等. 硝普鈉控制性降壓對腦脊液和血中乳酸濃度的影響. 中華麻醉學雜志. 1994, 14(5): 352-354.
18.	王秋筠, 孟慶云, 柳順鎖, 等. 七氟醚控制性降壓對腦代謝的影響. 中華麻醉學雜志, 2000, 20(5): 270-273.
19.	徐仲煌, 任洪智, 黃宇光, 等. 控制性降壓期間腦組織血流及氧供需平衡狀況的臨床研究. 中國醫學科學院學報, 2000, 22(4): 360-363.
20.	張素和, 丁叁強, 楊少輝. 異丙酚控制性降壓對顱腦手術腦氧供需平衡的影響. 貴州醫藥, 2001, 25(6): 500-502.
21.	林財珠, 張良成, 趙建英, 等. 顱腦手術控制性降壓時腦脊液乳酸含量變化的觀察. 臨床麻醉學雜志, 1994, 10(6): 337-338.
22.	王秋筠, 孟慶云, 柳順鎖, 等. 七氟醚控制性降壓對腦氧供需平衡的影響. 臨床麻醉學雜志, 2000, 16(8): 385-387.
23.	Michenfelder JD, Theye RA. Canene systemic and cerebral effects of hypotension induced by hemorrhage, trimethaphan, halothane, or nitroprusside. Anesth, 1977, 46: 188-195.
24.	Persson L, Hardemark HG, Gustafsson J, el a1. S-lO0 protein and neuronspecific enolase in cerebrospinal fluid and serum：markers of cell damage in human centra1 nervous system. Stroke, 1987, 18: 911-918.
25.	Wiesmann M, Missler U, Hagenstrom H, et a1. S-100 protein plasma levels after aneurysmal subarachnoid haemorrhage. Acta Neurochir(Wien), l997, 139: 1155-1160.
26.	Shaaban Ali M, Harmer M, Vaughan R. Serum S100 protein as a marker of cerebral damage during cardiac surgery. Br J Anoesth, 2000, 85: 287-298.
27.	Johnsson P. Markers of cerebral ischemia after cardiac surgery. Cardiothorac Vasc Anesth, 1996, 10: 120-126.
28.	Ingebrigtsen T, Romner B. Serial S-100 protein serum measurements related to early magnetic resonance imaging after minor head injury. Case report. J Neurosurg, 1996, 85: 945-948.
29.	Kilminster S, Treasure T, McMillan T, et al. Neuropsychological change and S-100 protein release in 130 unselected patients undergoing cardiac surgery. Stroke, 1999, 30: 1869-1874.
30.	Herrmann M, Ebert AD, Galazky l, et al. Neurobehavioral outcome prediction after cardiac surgery - role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke, 2000, 31: 645-650.
31.	Pasch T, Huk W. Cerebral complications following induced hypotension. Eur J Anaesthesiol, 1986, 3: 299-312.
32.	Townes BD, Dikmen SS, Bledsoe SW. Neuropsychological changes in a young, healthy population after controlled hypotensive anesthesia. Anesth-Analg, 1986, 65(9): 955-999.
33.	Williams-Russo P, Sharrock NE, Mattis S, et al. Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology, 1999, 91: 926-935.

1. 王婷. 血液稀釋聯合控制性降壓對機體生理的影響. 國外醫學麻醉學與復蘇分冊, 2002, 23(6): 355-357.
2. Mincheff Ms, Meryman HI. Blood tranfusion, blood storuge, and immunodulation. Immunol Invest, 1995, 24(12): 303.
3. 鄧碩曾. 輸血與血漿代用品. 見: 陳伯鑒, 主編. 臨床藥理學. 第1版. 北京: 人民衛生出版社, 2000. 580-593.
4. Chen SY, Zhu XL, Zhang YM, et al. Clinical application of intraoperative autologous blood transfusion. Di-si jun yi Daxue Xubao (J Fourth Mil MedUniv), 2001, 22(6): 542-544.
5. 安剛. 管理循環的技術－控制性低血壓. 引進國外醫藥技術與設備, 1999, 5(11): 11.
6. 黃美清. 控制性降壓在臨床麻醉中的應用進展. 華夏醫學, 2002, 15(3): 425-427.
7. Degoute CS, Ray MJ, Manchon M, et al. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesth, 2001, 48(1): 20-27.
8. 計根林, 張進, 熊東方, 等. 尼卡地平和烏拉地爾經蝶垂體腺瘤術中迅速降壓效果的比較. 第四軍醫大學學報, 2000, 21(9): 1118-1120.
9. 王天龍, 齊淡琴. 尼卡地平在臨床麻醉中的應用. 國外醫學?麻醉學與復蘇分冊, 2000, 21(1): 40-43.
10. Endoh H, Honda T, Ohashi S, et al. The influence of nicardipin-, nitroglycerin-and prostaglandin El-induced hypotension on cerebral pressure autoreguration in adult patients during propofol-fentanyl anesthesia. Anesth Analg, 2002, 94(1): 169-173.
11. Endoh H, Honda T, Komura N, et al. The effects of nicardipine on dynamic cerebral auto regulation in patients anesthetized with propofol and fentanyl. Anesth Analg, 2000, 91(3): 642-646.
12. Sartcaoglu F, Celiker V, Basgul E, et al. The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery. Eur J Anaesthesiol, 2005, 22(2): 157-159.
13. Suttner SW, Piper SN, Lang K, et al. Cerebral effects and blood sparing efficiency of sodium nitroprusside-induced hypotension alone and in combination with acute normovolaemic haemodilution. Br J Anaesth, 2001, 87(5): 699-705.
14. Thompson GE, Miller RD, Stevens WC, et al. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology, 1978, 48(2): 91-96.
15. 韓如泉, 李樹人, 王保國, 等. 異氟醚控制性降壓對顱內動脈瘤夾閉術病人腦脊液中S100B蛋白含量的影響. 中華麻醉學雜志, 2004, 24(4): 272-275.
16. 韓如泉, 凌大林, 李樹人, 等. 異氟醚控制性降壓對顱內動脈瘤夾閉術血中S100B含量的影響. 臨床麻醉學雜志, 2004, 20(1): 13-15.
17. 林才珠, 張良成, 楊錫馨, 等. 硝普鈉控制性降壓對腦脊液和血中乳酸濃度的影響. 中華麻醉學雜志. 1994, 14(5): 352-354.
18. 王秋筠, 孟慶云, 柳順鎖, 等. 七氟醚控制性降壓對腦代謝的影響. 中華麻醉學雜志, 2000, 20(5): 270-273.
19. 徐仲煌, 任洪智, 黃宇光, 等. 控制性降壓期間腦組織血流及氧供需平衡狀況的臨床研究. 中國醫學科學院學報, 2000, 22(4): 360-363.
20. 張素和, 丁叁強, 楊少輝. 異丙酚控制性降壓對顱腦手術腦氧供需平衡的影響. 貴州醫藥, 2001, 25(6): 500-502.
21. 林財珠, 張良成, 趙建英, 等. 顱腦手術控制性降壓時腦脊液乳酸含量變化的觀察. 臨床麻醉學雜志, 1994, 10(6): 337-338.
22. 王秋筠, 孟慶云, 柳順鎖, 等. 七氟醚控制性降壓對腦氧供需平衡的影響. 臨床麻醉學雜志, 2000, 16(8): 385-387.
23. Michenfelder JD, Theye RA. Canene systemic and cerebral effects of hypotension induced by hemorrhage, trimethaphan, halothane, or nitroprusside. Anesth, 1977, 46: 188-195.
24. Persson L, Hardemark HG, Gustafsson J, el a1. S-lO0 protein and neuronspecific enolase in cerebrospinal fluid and serum：markers of cell damage in human centra1 nervous system. Stroke, 1987, 18: 911-918.
25. Wiesmann M, Missler U, Hagenstrom H, et a1. S-100 protein plasma levels after aneurysmal subarachnoid haemorrhage. Acta Neurochir(Wien), l997, 139: 1155-1160.
26. Shaaban Ali M, Harmer M, Vaughan R. Serum S100 protein as a marker of cerebral damage during cardiac surgery. Br J Anoesth, 2000, 85: 287-298.
27. Johnsson P. Markers of cerebral ischemia after cardiac surgery. Cardiothorac Vasc Anesth, 1996, 10: 120-126.
28. Ingebrigtsen T, Romner B. Serial S-100 protein serum measurements related to early magnetic resonance imaging after minor head injury. Case report. J Neurosurg, 1996, 85: 945-948.
29. Kilminster S, Treasure T, McMillan T, et al. Neuropsychological change and S-100 protein release in 130 unselected patients undergoing cardiac surgery. Stroke, 1999, 30: 1869-1874.
30. Herrmann M, Ebert AD, Galazky l, et al. Neurobehavioral outcome prediction after cardiac surgery - role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke, 2000, 31: 645-650.
31. Pasch T, Huk W. Cerebral complications following induced hypotension. Eur J Anaesthesiol, 1986, 3: 299-312.
32. Townes BD, Dikmen SS, Bledsoe SW. Neuropsychological changes in a young, healthy population after controlled hypotensive anesthesia. Anesth-Analg, 1986, 65(9): 955-999.
33. Williams-Russo P, Sharrock NE, Mattis S, et al. Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology, 1999, 91: 926-935.

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控制性降壓對大腦影響的系統評價

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《中國循證醫學雜志》

控制性降壓對大腦影響的系統評價

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