2023年神經(jīng)外科麻醉進(jìn)展

nimumalveolarconcentration,MAC)]組或丙泊酚全憑靜脈麻醉(6~8mg·k-troencephalogram,EEG)振蕩(BIS較低),在使用右美托咪定時BIS下降，EGα功率增強(qiáng))或BIS組(手術(shù)期間BIS維持在40~60)。研究結(jié)果表明，EEG一項(xiàng)關(guān)于顱腦手術(shù)中腦松弛監(jiān)測的試驗(yàn)研究了視神經(jīng)鞘直徑(opticnervesheathdiameter,ONSD)和心率變異性(heartratevariability,HRV)參數(shù)pressure,ICP)高常與明顯的自主神經(jīng)功能障礙相關(guān)。該研究納入了58例接受幕上腦腫瘤手術(shù)V參數(shù)的變化以及CT分級可以作為ICP增加的替代標(biāo)志物，幫助預(yù)測術(shù)中大腦術(shù)中血流動力學(xué)管理，包括靜態(tài)參數(shù)(中心靜脈壓、平均動脈壓等)和動態(tài)參數(shù) (每搏輸出量變化等)。然而，靜態(tài)參數(shù)對液體反應(yīng)性的預(yù)測能力較差，動態(tài)參儀指導(dǎo)的目標(biāo)導(dǎo)向血流動力學(xué)管理對神經(jīng)外科術(shù)后并發(fā)癥發(fā)生率的影響[6],該研究招募了34例計(jì)劃接受擇期神經(jīng)外科手術(shù)的成年患者，將患者隨機(jī)分為對照分法疼痛評分(平均在術(shù)后6d內(nèi)進(jìn)行)可以預(yù)測開顱手術(shù)后1年的持續(xù)疼痛。一項(xiàng)Meta分析比較了頭皮神經(jīng)阻滯(scalpnerveblock,SNB)與非SNB α百分比和α-δ比對于預(yù)測腦缺血的最佳閾值分別較基線降低14%、21%,結(jié)2.2煙霧病(moyamoyadisease,MMD)患者的麻醉管理MMD是一種慢性腦血管疾病，常發(fā)生于5歲左右的兒童和40歲左右的成年顳淺動脈-大腦中動脈分支吻合術(shù)時應(yīng)用腦氧飽和度析中，嚴(yán)格的圍手術(shù)期管理[比值比(oddsratio,OR)0.163,95%置信區(qū)間(confidenceinterval,CI)0.027~0.979,P=0.047]和術(shù)前腦梗死程度評分(0R1.505,95%CI1.128~2.009,P=0.0062.3急性缺血性腦卒中(acuteischemicstroke,AIS)患者的麻醉管理AIS血管內(nèi)治療(endovasculartreatment,EVT)期間最佳麻醉方式的選擇仍是本年度的研究熱點(diǎn)。一項(xiàng)匯總了7個隨機(jī)對照試驗(yàn)的Meta分析顯示，相0d內(nèi)的神經(jīng)功能獨(dú)立性，但也顯著增加了肺炎發(fā)生的風(fēng)險(xiǎn)[30]。與此同時，在3其他一些研究指出，無論是全麻還是非全麻，麻醉方法對前循環(huán)AIS90d神經(jīng)功程中可能是一個關(guān)鍵的治療目標(biāo)[40]。改良Ranki2.4動脈瘤性蛛網(wǎng)膜下腔出血(aneurysmalitz等[44]前瞻性地分析了在分級不良(世界神經(jīng)外科學(xué)會分級4~5級)的aSA滲鹽水可有效降低ICP和腦水腫(推薦等級2a,證據(jù)等級B-NR);②麻醉目標(biāo)Payen等[56]將重度TBI16h之內(nèi)的患者隨機(jī)分配至單獨(dú)監(jiān)測ICP組和ICP/raneanesthesiaandtotalintravenousanestudy[J].BMCAnesthesiol,2023,23(1):15.DOI:10.1186/s12871-023-andadverseeventsassociatedwithdesfluranendergoingsupratentorialcraniotomy:asystematicreview[J].JNeurosurgAnesthesiol,2024,36(1):20-28.DOI:10.1097/ANA.0000000000[3]TsaousiGG,PezikoglouI,NikopoulouA,etal.Comparisonofequiosmolardosesof7.5%hypertonicsalineand20%mannitoloncereloxygenationstatusandtentorialcraniotomy:arandomizedcontrolledtrial[J].JNeurosurgAnesthesiol,2023,35(1):56-64.DOI:10.1097/ANA.0000000000000791.[4]LinFS,ShihPY,SungCogram-guidedtotalintravenousanestmy:apropensityscore-matchedanalysis[J].Korean24,77(1):122-132.DOI:10.4097/kja.23118.[5]KrishnakumarM,GopalakrishnaKNrativeassessmentofoptComput,2023,37(3):765-773.DOI:10.1007/s10877-022-00942-x.[6]Hrdy0,DubaM,Dolezelovaofpostoperativecomplicationsinneurosbilityrandomizedcontrolledtrial[J].PerioperMed(Lond),2023,12(1):32.DOI:10.1186/s13741-023-00321-3.[7]PhoowanakulchaiS,IdaM,Naito[J].BMCAnesthesiol,2023,23(1):115.DOI:10.1186/s12871-023-020meta-analysisofrandomizedtrials[J].MinervaAnestesi-ol,2023,89(1-2):85-95.DOI:10.23736/S0375-9393.22.16775-1.omesat24-48hoursfollowingcraniotomy:anupdaewandmeta-analysisofrandomizedcontrolledstudies[J].PainPract,2023,23(2):136-144.DOI:10.1111/papr.13167.[10]NassarH,Sarhanotomy:arandomized,controlledtrial[J].JNeurosurg24,36(2):159-163.DOI:10.1097/ANA.0000000000000899.cisionalpainafterbraintumorresectierandomizedcontroltrial[J].Aneopioidrequirementersupratentorialcraniotomies[J].JNeurosurgAnesthesiol,2023,35(3):307-312.DOI:10.1097/ANA.0000000000000842.[13]McCulloughIL,ShteamerJW,ErwoodAM,et-esthesiaforcraniotomy[J].JNeurosurgAnesthesiol,2023,35(1):80-85.DOI:10.1097/ANA.0000000000000797.braintumourresectionforpreventionofpostondomisedtrial[J].BrJAnaesth,2023,130(2):e307-e316.DOI:10.1016/j.bja.2022.10.041.[15]LiT,ZhangY,ChenX,eter-natremiawithou-th,2024,92:111294.DOI:10.1016/j.jclinane.2023.111294.CanNIRSbeasurrogateindicatorofelectivterectomy?Asingle-centerobservatio[J].JClinMonitCectiveanalysisoncarotidendarterectomy:inestesiol,2023,89(7-8):636-642.DOI:10.23736/S0375-9393.esofdexmedetomidinewithlocalregidarterectomy[J].AnnVascSurg,2023,89:174-181.DOI:10g.2022.08.009.[19]GaoJ,YangC,JiQ,etal.Effectofremimazolamver[20]ZhaoG,FengG,ZhaoL,etal.Applicationofquatientsundergoingcarotidendarterectomy[J].FrontNeurol,2023,14:1159788.DOI:10.3389/fneurementforcarotidendarteed,controlledtrial[J].JClinMed,2023,12(15):4885.DOI:10.3390/[22]KirchhoffF,EcksteinHH.Locoregionalanaesthesiaandperativeangiographyincarotidendart3,65(2):223-232.DOI:10.1016/j.ejvs.2022.10.0[23]ZhouC,LiM,ZhengL,etal.EfficacyteganglionblockinpatientsunderVascular,2023,31(4):708-716.DOI:10.1177/17085381221084800.[24]AziziPM,Wijeysunderionbetweenhospitalpostoperativeesaftervascularsurgery[J].AnesthAnalg,2023,137(3):6290I:10.1213/ANE.0000000000006411.[25]MehtaV,TharpP,CaruthersCnointensivecareunitstay[J].JVascSurg,2023,77(2):555-558.DOI:10.1016/j.jvs.2022.09.026. 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