高渗氯化钠羟乙基淀粉40注射液对脑肿瘤患者术中脑氧代谢的影响

目的观察高渗氯化钠羟乙基淀粉40注射液（HH40）对脑肿瘤患者脑氧代谢的影响。方法择期行大脑半球肿瘤切除术患者60例，男38例，女22例，ASAI-II级，随机分为3组（n=20），HH404ml／kg组（HH40A组）、HH402ml／kg组（HH40B组）和20％甘露醇4ml／kg组（M组）。常规诱导后行右侧颈内静脉逆行置管至颈静脉球。3组均行七氟烷吸人麻醉，待七氟烷呼气末浓度达1.2最低有效肺泡气浓度（MAC）后，在15min内静脉滴注各组实验液体。在静滴前即刻（T0）、静滴后15min、30min、60min、120min（T1～T4）记录平均动脉压（MAP）、心率（HR）、中心静脉压（CVP），采集5ml动脉血和5ml颈静脉球血行血气分析和血红蛋白测定；计算出各时间点脑氧代谢值。结果3组各时点MAP和HR比较差异无显著意义（P〉0．05）。与1、0时比较，HH40A组HH40B组脑氧摄取率在T1～T4时降低（HH40A组P〈0．01，HH40B组P〈0．05），M组脑氧摄取率在T1～T3时降低（P〈0．05）。HH40A组较M组在T1～T4时刻脑氧摄取率降低，其中他～T4时刻P〈0．01。HH40B组与M组各时刻脑氧摄取率均无明显差异。HH40A组与HH40B组比较，两组于T2～T4时刻脑氧摄取率有差异，其中T2和T4时亥4差异明显，P〈0．01。结论HH40与20％甘露醇均能降低脑氧代谢。相同剂量的HH40注射液较20％甘露醇降低脑氧代谢效果好，且作用时间长。

The effect of hypertonic sodium chloride hydroxythel starch 40 injection on cerebral oxygen metabolism of cerebral tumor patients

Objective To observe the effect of hypertonic sodium chloride hydroxythel starch 40 injection （HH40） on cerebral oxygen metabolism of cerebral tumor patients. Methods Sixty cerebral tumor patients, receiving craniotomy,ASA I- II, were randomly divided into three groups. Group A （HH40 4ml/kg）, Group B（HH40 2ml/kg）, Group M （mannitol 4ml/kg）. All patients accepted general anesthesia. Insert a central venous catheter into jugular bulb after induction. When the exhalant concentration of sevoflurane reach 1.2MAC,all patients received an intravenous drip infusion of experimental fluid within 15 minutes. Measurements were taken before the infusion （TO） and 15, 30,60,120minutes after the infusion （TI-T4） including MAP, HR and CVP. Blood samples were collected from jugular bulb and radial artery at five time points to make blood gas analysis and hemoglobin determination. Calculated cerebral oxygen metabolism cost. Results There were no significant differences of MAP and HR in all groups. Compared with TO, the rate of cerebral extraction of oxygen （CERO2） decreased from T1 till T4 in Group A and Group B. But in Group M, the CERO2 decreased from Tl till T3 but T4. Compared with Group M, the CERO2 decreased from T1 till T4 in Group A but Group B. Compared with Group B, the CERO2 decreased from T2 till T4 in Group A. Conchlsion HH40 can decrease cerebral oxygen metabolism as mannitol 20%, but the same dose of HH40 is more significant than mannitol 20% to decrease oxygen metabolism, and acts a longer duration.