摘要
目的观察3%高渗盐水(HTS)对颅内肿瘤患者脑脊液压力(CSFP)、血液动力学及电解质的影响,探讨3%HTS用于降低颅内肿瘤患者颅内压的可行性。方法择期行大脑半球胶质瘤切除术患者加例,男23例,女17例,ASA Ⅰ或Ⅱ级,随机分为两组(n=20),HTS组和M组,麻醉诱导前行L3,4刺置管监测CSFP。两组均行静吸复合麻醉,异氟醚呼气末浓度达1MAC后,在15 min内输注3%HTS(5.33 ml/kg)和20%甘露醇(1g/kg)。在输注前即刻(T0)、输注后15、30、60、90、120 min(T1-5)记录平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、尿量,采集5 ml动脉血测定血浆Na+、K+、pH、血浆渗透压;在T0-4监测CSFP,计算脑灌注压(CPP)。结果两组各时点MAP和HR比较差异无统计学意义(P>0.05)。与T0时比较,HTS组CSFP在T2-4时降低,M组在T3、T4时降低,HTS组CVP在T1-4 时升高,M组在T4、T5时降低,两组各时点血浆渗透压均升高,两组不同时点血浆Na+和K+浓度均有改变但仍在正常范围内(P<0.05)。与M组比较,HTS组CSFP在T2时降低,CVP在T5时升高,尿量在T1-2、T2-3、T3-4、T4-5时段减少(P<0.05)。结论3%HTS可安全地用于颅内肿瘤患者,其降低颅内压的作用优于20%甘露醇,且在降低颅内压的同时,不影响血液动力学。
Objective To investigate the effects of 3 % hypertonic saline （HTS） on cerebrospinal fluid pressure （CSFP）, hemodynamics and electrolytes and the feasibility of reducing intracranial pressure （ICP） with 3 % HTS in patients with brain tumor. Methods This study was approved by our institutional ethics committee. Forty consenting ASA Ⅰ or Ⅱ patients of both sexes （23 males, 17 females） undergoing elective surgical excision of supratentorial glioma were randomly divided into 2 groups （ n = 20 each） ： 3% HTS group and 20% mannitol group. The patients were fasted for 12 h before operation and premedicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg. Anesthesia was induced with midazolam 1.5-2.0 mg, fentanyl 3μg·kg^-1 , 2.5 % sodium pentothal 4-6 mg·kg^-1 and vecuronium 0.1 mg·kg^-1 . The patients were mechanically ventilated （VT = 8-10 ml·kg^-1 , RR = 12 bpm, PETCO2 = 30-35 mm Hg） after tracheal intubation. Anesthesia was maintained with isoflurane inhalation and vecuronium infusion at 0.05 mg·kg^-1· h^- 1. A bolus of fentanyl 4 μg·kg^-1 was given i.v. 5 min before incision. Before induction of general anesthesia a 17 G catheter was inserted into subarachnoid space at L3.4 for measurement of CSFP. Left radial artery and right internal jugular vein were cannulated for BP and CVP monitoring and blood sampling. When end-tidal isoflurane concentration was maintained at 1 MAC and hemodynamics stabilized for 15 min, 3% HTS 5.35 ml·kg^-1 or 20% mannitol 1 g·kg^-1 was infused i.v. over 15 min. MAP, HR, CVP and urine output were measured and recorded and arterial blood samples were taken for blood gas analysis and determination of plasma Na^＋ and K^＋ concentrations, pH and plasma osmotic pressure before infusion （To , baseline） and 15, 30, 60, 90 and 120 min after infusion （T1-5）. CSFP was measured at T0-4 and cerebral porfusion pressure （CPP） was calculated （CPP = MAP- ICP）.Results The two groups were comparable with regard to sex, age, body weight and the extent of cerebral midline deviation （ 〈 5 mm）. There was no significant difference in MAP and HR at all time points between the two groups. CSFP was significantly decreased at T2~4 in HTS group and at T3,4 in manitol group as compared to their baseline values （ T0 ）. CVP was significantly increased at T1~4. in HTS group but decreased at T4.5 in mannitol group as compared with their baseline values （T0 ） . Plasma osmotic pressure was significantly increased at Tt.5 and the plasma Na^＋ and K^＋ concentrations were maintained within normal range in both groups. Urine output was significantly higher after infusion （T1~5 ） in mannitol group than in HTS group. There was no significant change in CPP in both groups. No side effect was observed in either group. Conclusion 3 % hypertonic saline can be used safely and effectively to reduce CSFP during surgical excision of supratentorial glioma and is more effective than 20% mannitol.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2005年第7期485-489,共5页
Chinese Journal of Anesthesiology
关键词
高渗盐水
颅内肿瘤
颅内压
甘露醇
血液动力学
Saline solution, hypertonic
Brain neoplasms
Intracranial pressure
Feasibity studies
