3%高渗氯化钠对神经外科手术患者炎症反应的影响

目的观察3%高渗氯化钠对神经外科手术患者血浆炎症反应程度的影响。方法选择拟于全身麻醉下行幕上深部肿瘤切除术的患者50例,男30例,女20例,年龄18~65岁,ASAⅠ或Ⅱ级。运用电脑随机数字表将患者分为两组,每组25例。切皮前MT_组予以20%甘露醇1g/kg,HS组予以3%高渗氯化钠溶液2ml/kg,15min内滴注完毕。记录诱导前10min(T_0)、滴注3%高渗氯化钠溶液(MT_组为20%甘露醇)时(T_1)、滴注完成即时(T_2)、滴注完成后30 min(T_3)、60 min(T_4)的MAP、HR、尿量、颅内压(ICP)和脑灌注压(CPP),检测T_0~T_4时患者内环境及电解质水平,并记录苏醒时间和术中出血量;检测T_0~T_4时血浆T_NF-α、IL~(-1)β和IL-6水平。结果 T_2~T_4时HS组ICP明显低于MT_组,T_3、T_4时HS组尿量明显少于MT_组,HS组T_NF-α、IL-6和IL~(-1)β明显低于MT_组(P0.05)。结论与20%甘露醇比较,3%高渗氯化钠能更有力地抑制神经外科手术患者血浆炎症反应。

Effect of 3% hypertonic saline on inflammatory response of neurosurgery patients

Objective To evaluate the effect of 3% hypertonic saline on inflammatory responses of neurosurgery patients.Methods Fifty patients,ranging from 18-65 years old,ASA Ⅰor Ⅱ,including 30 males and 20 females,scheduled for deep supratentorial tumor resection were se-lected randomly.Then the patients were divided into two groups (named group MT and group HS) according to the computer random number table,with 25 patients in each group.Before skin incision, patients in group HS were injected with 3% hypertonic saline 2 ml/kg within 1 5 min intravenously, while patients in group MT were injected with 20% mannitol at the same time.MAP,HR,volume of urine,intracranial pressure (ICP),and cerebral perfusion pressure (CPP)were recorded at 10 min before anesthesia induction (T0 ),the time when injection of hypertonic saline or mannitol started (T1 ),the time when injection of hypertonic saline or mannitol ended (T2 ),30 min after end of injec-tion (T3 )and 60 min after end of injection (T4 ).The total volume of blood loss were also recorded. Peripheral venous blood were collected at T0-T4 for TNF-α, IL-1β and IL-6 level analysis. Results Compared to group MT,ICP in group HS were significantly lower at T2-T4 ,and urine vol-ume in group HS were much lower at T3 ,T4 .Moreover,plasma level of TNF-α,IL-6 and IL-1β in group HS were also significantly lower.Conclusion Intravenous injection of 3% hypertonic saline be-fore skin incision during deep supratentorial tumor resection would inhibits inflammation response more effectively than mannitol injected at the same time.