高渗氯化钠羟乙基淀粉40注射液对颅脑手术患者颅内压及脑氧合的影响

目的 观察高渗氯化钠羟乙基淀粉40(HSH40)注射液对颅脑肿瘤手术患者颅内压及脑氧合的影响.方法 择期颅脑肿瘤手术患者30例,随机均分为2组:试验组(HSH40注射液组)与对照组(20%甘露醇组),2组均用静吸复合全麻,在15 min内,试验组与对照组分别静脉输注HSH40注射液4 mL·kg~(-1)和20%甘露醇1 g·kg~(-1);于不同时点监测平均动脉压(MAP)、脑脊液压(CSFP)及尿量,并计算脑灌注压(CPP)、脑动脉和颈内静脉氧含量、脑动静脉血氧含量差(Da-jvO_2)及脑氧摄取率(CERO_2).结果 与输注前比较,在输注完15 min后2组CS-FP均降低;试验组在输注后30,60 min时,CPP升高;在60,120 min时,2组颈内静脉血氧饱和度(SjvO_2)升高而Da-jvO_2及CERO_2降低(P<0.05);与对照组比较,试验组在30 min时CSFP降低;尿量在各时段均减少(P<0.05).结论 HSH40对颅脑肿瘤手术患者可降低其颅内压且优于20%甘露醇;且HSH40可改善颅脑肿瘤患者的脑氧代谢.

Effects of hypertonic saline/hetastarch 40 injection on intracranial pressure and cerebral oxygenation in patients undergoing neurosurgery for supratentorial glioma

Objective To investigate the effects of hypertonic saline/hetastarch 40 injection (HSH40) on intracranial pressure and cerebral oxygenation in patients undergoing neurosurgery for supratentorial glioma. Methods Thirty adult ASA grade Ⅰ or Ⅱ patients undergoing excision of supratentorial glioma were randomly divided into 2 groups: HSH40 4 mL ·kg~(-1) (trial group, 15 cases) or 20% mannitol 1 g·kg~(-1) (control group, 15 cases) was given intravenously over 15 min when hemodynam-ics was stable. Mean arterial pressure (MAP) , cerebrospinal fluid pres-sure(CSFP) and urine output were measured and recorded at different time-points. Cerebral arterial to jugular venous oxygen content differ-ences (Da-jvO_2) and cerebral oxygen extraction rate (CERO_2) were calculated. Results As compared to their baseline, CSFP significantly decreased from 15 min to 120 min after infusion in the 2 groups, and the reduction at 15 min in trial group was more significant than that in control group. Urine output was significantly lower in trial group than that in control group. Da-jvO_2and CERO_2 significantly decreased and internal jugular venous oxygen saturation(SjvO_2) markedly increased at 60 min, 120 min as compared to their baseline in the 2 groups. Conclusion HSH40 is more effective than 20% mannitol in reducing CSFP and can improve cerebral oxygenation during excision of intracranial tumour.