关键词: 垂体腺瘤;显微外科手术;脑氧平衡

    摘 要:目的 探讨鞍上扩展型垂体腺瘤(PASE)经蝶显微手术麻醉的特殊性以及术中蛛网膜下腔注水后颅内压(ICP)增高对循环和脑氧供需平衡的影响. 方法 回顾性总结198例PASE患者经蝶入路行肿瘤切除术的麻醉程序.术中持续静脉滴注20mg·L-1 的普鲁卡因1.0mg·kg-1 ·min-1 或间断辅以5～10mL·L-1 异氟醚吸入维持麻醉，通过腰蛛网膜下腔予置一导管注射生理盐水，增高ICP使鞍上瘤体进入手术野以利切除，并监测了15例患者注水前后循环和脑氧供需平衡的变化. 结果 麻醉过程平稳，术后179例(90.1%)在15min内清醒拔管，无严重麻醉并发症.术中向蛛网膜下腔注射生理盐水(平均44mL)，虽然引起ICP明显升高、CPP显著降低，但心率、平均动脉压和反映脑氧供需平衡的各参数均未变化. 结论 PASE经蝶入路显微手术全麻期间，在ICP监测下经腰蛛网膜下腔注生理盐水(35～70mL)尚能维持循环稳定和脑氧供需平衡.

    Anesthesia for transsphenoidal microsurgical re┐moval of pituitary adenomas with suprallar exten┐sions

    WANG Qiang CHEN Shao-Yang NING Xiao-Wen XIONG Li-Ze HU Wen-Neng HU Sheng ZENG Xiang-Long

    1 Department of Anesthesiology，Xijing Hospital，Fourth Military Medical University，Xi'an710033，China，

    2 Department of Anesthesiology，4th People's Hospital of Xi'an，Xi'an710004，China

    Keywords:pituitary adenoma;microsurgery;cerebral oxy-genation

    Abstract:AIM To probe the characteristics of anesthet-icprocedure for the removal of pituitary adenomas with suprasellar extensions(PASE)and effect of intracranial pres-sure(ICP)elevation in situ by infusion of saline into sub-arachnoid space during the procedure on circulation and cere-bral oxygen supply/consumption balance.METHODS The data of anesthetic procedure were reviewed in198PASE pa-tients undergoing transsphenoidal microsurgery.Anesthesia was maintained with continuous intravenous infusion of2%procaine at1.0mg·kg-1 ·min-1 or combined with0.5%～1.0%isoflurane inhalation.Saline was slowly injected through a catheter inserted into the lumbar subarachnoid space to increase the ICP and force the suprasellar tumor into the operative field for aiding the removal of the tumor.Pa-rameters of circulation and cerebral oxygenation before and after the infusion of saline into subarachnoid space were mon-itored in15patients under general anesthesia with intra-venous procaine.RESULTS All the patients were stable and smooth during anesthesia.179patients(90.1%)were con-scious and intubation was extracted within15min after the surgery.There were no complications related to anesthesia.44mL(mean)of saline was injected into subarachnoid space ......