高渗高胶溶液降低颅脑肿瘤患者颅内压的疗效观察

目的观察高渗氯化钠羟乙基淀粉40溶液（HSS40）对颅脑肿瘤手术患者颅内压及循环稳定的影响。方法择期颅脑肿瘤手术患者26例，随机分为HSS40组和20％甘露醇组（M组），每组13例，局麻下经L3～4椎间隙穿刺置管监测脑脊液压(CSFP)。两组均采用静吸复合全麻，在15?min内静脉输注HSS40注射液200?mL和20％甘露醇250?mL，分别于输注前（T0）、输注完即刻（T1）、输注完15?min（T2）、30?min（T3）、60?min（T4）和120?min（T5）记录平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）、CSFP及尿量，计算脑灌注压（CPP）。结果两组患者各时点MAP、HR比较，差异无统计学意义（P＞0.05）。与T0比较，HSS40组CVP在T2～T4时升高， M组在T4、T5时降低；HSS40组CSFP在T2～T5时降低，M组在T3～T5时降低；HSS40组CPP在T3时升高，M组在T4时升高（P＜0.05）；与M组比较，HSS40组CSFP在T3时点降低，CVP在T4、T5时升高；HSS40组尿量在T2 3、T3 4、T4 5时段减少（P＜0.05）。结论在颅脑肿瘤手术中，HSS40溶液降低颅内压的作用优于20%甘露醇，并且有助于术中循环稳定。

Effect of hypertonic saline/hetastarch solution on intracranial pressure in patients with intracranial tumors

To explore the effect of hypertonic saline/hetastarch solution on intracranial pressure in patients undergoing surgery for intracranial tumours. MethodsTwenty six ASA Ⅰ or Ⅱ patients, aged 28 71 years and 50 89?kg in weight undergoing intracranial tumor removal were randomly divided into two groups (13 in each ):groupⅠwith hypertonic saline/hetastarch solution(HSS40) and group Ⅱ with 20% mannitol (M). All patients were intramuscularly pre medicated with 0.1g phenobarbital and 0.5?mg atropine. Under local anesthesia, an epidural catheter (17?G) was inserted into the subarachnoid space at the L3 4 interspace for measurement of cerebral spinal fluid (CSF) pressure. Anesthesia was induced with 3?μg/kg fentanyl, 4?mg midazolam, 0.3?mg/kg etomidate and 0.1?mg/kg vecuronium. Then patients were mechanically ventilated (VT=10?mL/kg,RR=12?bpm,I∶E=1∶2,FiO2=100%). PETCO2 was maintained 30 35?mmHg by adjusting the tidal volume and respiratory rate. Anesthesia was maintained with inhalation of 1.5% isoflurane. The left radial artery was cannulated for BP monitoring and blood sampling. The right internal jugular vein was cannulated for CVP monitoring. HSS40 200?mL or 20% mannitol 250?mL was intravenously given over 15?min when the hemodynamics were stable. MAP,HR,CVP and urine output were measured and recorded before HSS40 or mannitol infusion(T0), immediately after infusion(T1) and 15，　30，　60 and 120?min after infusion(T2 5).　Also CSFP was measured and CPP was calculated. ResultsThere were no significant differences in MAP and HR at all time points between the two groups. As compared with their baseline values at T0, CSFP was significantly decreased at T2 5 in the HSS40 group and at T3 5 in the mannitol group, and CVP was significantly increased at T2 4 in the HSS40 group but decreased at T4 5 in the M group.CSFP was significantly decreased at T3 and CVP increased at T4 5 in the HSS40 group as compared with the M group. Urine output was significantly higher after infusion(T2 5) in the mannitol group than in the HSS40 group. ConclusionHSS40 is more effective than 20% mannitol in reducing CSFP and improving hemodynamics during intracranial tumor removal.