Effects Of Controlled Hypotension On Intraoperative Cerebral Oxygen Saturation,Postoperative Cognitive Function And Neurological Prognosis In Patients With Intracranial Aneurysm Clipping

Objective:To investigate the effects of controlled hypotension with different drugs on intraoperative regional oxygen saturation(rSO2),postoperative cognitive function and neurological prognosis in patients with intracranial aneurysm clipping.Methods:108 patients with intracranial aneurysm clipping were selected,including 50 males and 58 females,aged 30-74 years old,ASA physical status Ⅰ or Ⅱ,Hunt-Hess 0-Ⅱ grade,randomly divided into three groups:Nitroglycerin group(group N,n=36),Sevoflurane group(group S,n=36)and Control group(group C,n=36).Controlled hypotension was started in group N and group S when neurosurgeons started exposuring aneurysm,stopped after aneurysm clipped.The MAP,HR and rSO2 were recorded before induction(T0),at the beginning of controlled hypotension(T1),after control began 10 min(T2),20 min(T3),30 min(T4),control stopped(clip finished,T5),after control stopped 10 min(T6),30 min(T7),at the end of operation(T8),and after extubation(T9).Assess cognitive function of 1 day before operation and 1 day,3 days and 7 days after operation by using Montreal Cognitive Function Assessment Scale(MoCA)and Mini Mental State Scale(MMSE).Neuron Specific Enolase(NSE)and S-100β protein levels were determined by ELISA of 1 day before surgery and 3 days after surgery.New neurological complications and important organ complications were recorded during hospitalization and the patients were followed up three months after surgery.Results:Compared with T0,the HR and the MAP of the three groups decreased at the time of T1-T8(P<0.05),while the rSO2 and MAP of the N and S groups decreased significantly at T2-T7(P<0.05),and were significantly lower than Group C.There was no significant difference in rSO2 of group C at each time point.There was no significant difference in MAP,HR and rSO2 between group N and group S.Compared with preoperative,the MMSE scores and MoCA scores of the three groups were significantly decreased(P<0.05),and the MMSE scores and MoCA scores of the three groups were significantly increased at 3 days after operation(P<0.05),the scores were no significant difference at 7 days after operation.And there was no significant difference in the scores between the three groups.Compared with preoperative,there was no significant difference in the incidence of POCD between the three groups at 1 day,3 days,and 7 days after surgery.The serum levels of NSE and S-100β protein in group N and the group S were increased(P<0.05),and were higher than those in group C,and decreased to the preoperative level 3 days after surgery.There were no significant differences in extubation time,operation time,hospital stay,the incidence of postoperative neurological complications and important organ complications between the three groups.Conclusion:Application of NIRS monitoring in intracranial aneurysm clipping has guiding significance for controlled hypotension.Controlled hypotension with nitroglycerin and sevoflurane can reduce rSO2,but it does not increase the incidence of postoperative cognitive dysfunction(POCD)and the incidence of nervous system and important organ complications,it is safe and feasible.