急性等容血液稀释对颅内肿瘤患者术中ICP、SvO2及VBL含量的影响  

Effects of acute normovolemic hemodilution on intraoperative intracranial pressure and cerebral oxygen metabolism in patients with intracranial tumor

作　　者：黄焕森[1] 郑进[1] 苏风华[1] 何雁冰[1] 

机构地区：[1]广州医学院第二附属医院麻醉科,广州510260

出　　处：《中华神经医学杂志》2010年第1期74-77,共4页Chinese Journal of Neuromedicine

基　　金：基金项目：广东省科技计划项目（2006836004011）

摘　　要：目的观察急性等容血液稀释（ANH）对颅内肿瘤患者术中颅内压（ICP）及颈内静脉血氧饱和度（SvO2）和乳酸（VBL）含量的影响。方法选择择期行幕上颅内肿瘤切除术患者42例，按随机数字表法分为ANH组（n=211和对照组（H=211。ANH组患者桡动脉放血同时颈内静脉输注等容量羟乙基淀粉，目标血球压积（Hct）=30％。对照组患者不行ANH。2组患者术中均用醋酸林格氏液维持生理需要量。监测2组患者ANH前、ANH后即时、30min、切开硬脑膜前ICP的变化及ANH前、ANH后30min、1h、术毕动脉氧分压（PaO2）、颈内静脉血氧分压（PvO2）、SvO2、VBL水平。结果2组患者各时间点ICP相比差异无统计学意义（P〉0．051；ANH后1h、术毕时对照组患者SvO2低于ANH组，差异有统计学意义（P〈0．05）：对照组患者ANH后1h、术毕与ANH前、ANH后30min相比SvO2下降，VBL水平升高，差异有统计学意义（P〈0．05）。结论以Hct=30％为稀释目标实施ANH，不增加颅脑手术患者的ICP，有利于脑组织的氧供和对氧的利用。Objective To investigate the effects of acute normovolemic hemodilution （ANH） on intraoperative intracranial pressure （ICP）, jugular venous oxygen saturation （SvO2）, and venous blood lactate （VBL） of patients with intracranial tumor. Methods Forty-two patients, elected to perform supratentorial intracranial tumor resection on some certain days, were randomly divided into ANH （n=21） and control （n=21） groups. Bloodletting was performed in the radial artery after anesthesia induction and the same amount ofhydroxyethyl starch was injected into the internal jugular vein at the same time so as to induce the haematocrit reaching to 30% in the ANH group. ANH was not performed in the control group. Acetated Ringer＇s solution was used during the operation in both groups. The level of arterial partial pressure of oxygen （PaO2）, arterial oxygen saturation （SaO2）, venous oxygen partial pressure （PvO2）, mixed venous O2 saturation （SvO2） and VBL was measured before hemodilution （T0）, 30 min after the hemodilufion （T1）, 1 h after the hemodilution （T2）, and at the time the operation was finished （T3） in both groups. And the changes of ICP before hemodilution （T0）, immediate after hemodilution （TO, 30 min after the hemodilution （TⅡ）, and before the endocranium was cut open （TⅢ） in both groups. Results The ICP value in the two groups was not significantly different at different time points; The level of SvO2 in the control group was significantly lower than that in the ANH group at T2 and T3 （P〈 0.05）; Significantly decreased level of SvO2 and increased level of VBL was found in the control group at T2 and T3 as compared with those in the control group at T0 and TII （P〈0.05）. Conclusion Maintaining ICP in patients with intracranial tumor during the operation through performing ANH with Hct reaching 30%, can significantly improve the oxygen supply and consumption in the brain tissue.

关 键 词：急性等容血液稀释 颅脑手术 颅内压 氧供需平衡 

分 类 号：R614[医药卫生—麻醉学]