经颅微血管减压术中不同剂量甘露醇对颅内压的影响

目的：比较不同剂量甘露醇注射液在经颅微血管减压术中对颅内压（ICP）的影响。方法：120例经颅微血管减压术的患者均分为3组，术中分别给予20％甘露醇注射液0．25g·kg^-1（A组）、0．5g·kg^-1（B组）、1g·kg^-1（C组）ivd，观察甘露醇注射液静脉滴注前（T1）、静滴后15min（T2）和30rain（r13）的ICP、MAP和尿量。术后由手术医生对降颅压效果进行主观评价。结果：各组在T1时点ICP无统计学差异。在他和，13时点，3组的ICP均有所降低；B和C组降低较A组明显。两组间差异无明显统计学意义。各时点，各组MAP无明显变化。T1～T2时间段（他．1），各组尿量随给予甘露醇的增加而增多；T1-13时间段（T3-1），B和C组的尿量较A组明显增多，两组间差异无明显统计学意义。降颅压效果的主观评价，B和C组的满意例数多于A组，两组间差异无明显统计学意义。结论：不同剂量的甘露醇注射液均可降低颅内压。用药后30min，0．5g·kg^-1和1g·kg^-1组降颅压作用相近，且都优于0．25g·kg^-1组。以0．5g·kg^-1甘露醇注射液用于经颅微血管减压术中，对降低颅内压是有效、安全的。

Effects of Mannitol with Various Doses on Intracranial Pressure in Transcranial Microvascular Decompression

Objective： To compare the effects of mannitol with different doses on intracranial pressure in transcranial microvascular decompression. Method ： One hundred and twenty patients for elective surgery of transcranial microvascular decompression were equally divided into 3 groups. The patients were given 20% mannitoi injection by intravenous infusion with dose of 0. 25 g·kg^-1l （group A）,0. 5g·kg^-1 （ group B） ,and 1 g·kg^-1 （ group C） ,respectively. ICP ,MAP and urine volume were recorded before the infusion （T1） ,15min after the infusion （T2） and 30rain after the infusion （T3）. Result： The ICP in every group was not significantly different at TI. The ICP of each group all reduced at T2 and ＇13. The ICP of group B and C were significantly lower than that of group A, and there was no significant difference between the two groups at T2 and 33. At each time point,there was no significant change in MAP of each group. From T1 to T2 （ T2-1 ）, the urine volume increased with the increase of mannitol dose. The urine volumes of group B and C were significantly more than those of group A from T1 to 33 （ 33-1 ） while there was no significant difference between the two groups. Conclusion： Doses of 0. 5 g·kg^-1 and 1 g·kg^-1 mannitiol intravenous infusion can reduce the intracranial pressure more significantly compared with 0. 25 g·kg^-1 mannitol intravenous infusion; however, there is no difference between the two doses. It is safe and effective to reduce the intracranial pressure with 0. 5g·kg^-1 mannitol infusion in transcranial microvascular decompression.