高渗盐溶液对神经外科手术患者血流动力学和呼吸功能的影响  

Effect of Hypertonic Saline on Hemodynamics and Oxygenation Index in Neurosurgical Patients

作　　者：孔晓琦[1] 须挺[1] 

机构地区：[1]苏州大学附属第一医院麻醉科,江苏苏州215006

出　　处：《中国血液流变学杂志》2013年第4期657-660,共4页Chinese Journal of Hemorheology

摘　　要：目的：观察高渗盐溶液对神经外科手术患者血流动力学和呼吸功能的影响。方法60例拟行择期神经外科开颅手术的患者（18～65岁），随机分为高渗盐组和甘露醇组，高渗盐组所有患者在麻醉诱导后30 min内给与3%氯化钠溶液500 mL，对照组诱导后30 min内给与20%甘露醇500 mL，后两组患者输入乳酸林格液5 mL？kg-1？h-1。监测平均动脉压（MAP）、心率（HR）、心排量（CO）、胸腔液体含量（TFC）和氧合指数（OI），同时观察硬脑膜张力、出血量、尿量、手术时间和拔管时间。结果与基础值相比，两组患者MAP和CO在麻醉诱导后显著降低，后逐渐升高，且高渗盐组更持久。与基础值相比，两组患者TFC和OI无明显改变，甘露醇和高渗盐均能显著地增加TFC和降低OI，甘露醇组在术毕恢复。高渗盐组具有更好的降低硬脑膜张力的作用。高渗盐组尿量为355±42 mL，而甘露醇组为680±59 mL。高渗盐组拔管时间为38±4 min，而甘露醇组为26±3 min。结论甘露醇和高渗盐都具有很好的稳定血流动力学和降低颅内压的作用，但是高渗盐可显著增加心排量和胸腔液体含量。Objective To investigate the effect of hypertonic saline on hemodynamics and oxygenation index in neurosurgical patients. Methods Sixty patients （18～65 years old） undergoing neurosurgery were randomly divided into hypertonic saline group or mannitol group. 3%NaCl 500 mL was infused after anesthesia induction within 30 minutes in hypertonic saline group. 20%mannitol 500 mL was infused in the other group. The mean artery pressure （MAP）, heart rate （HR）, cardiac output （CO）, thoracic lfuid content （TFC）, and oxygenation index （OI） were monitored and compared. The surgeons assessment on cerebral dura mater tension, bleeding volume, urine output, surgical time and extubation time were also recorded. Results Compared with baseline, MAP and CO decreased after anesthesia induction in both groups and recovered later with more signiifcance in hypertonic saline group. There was no difference in TFC and OI in both groups compared with baseline. Both hypertonic sa-line and mannitol can increase TFC and decrease OI, which will recover to normal in mannitol group. Hypertonic saline had a better effect to decrease the cerebral dura matter tension. The urine output was 355±42 mL in hyper-tonic group and 680±59 mL in mannitol group. The extubation time was 38±4 min in hypertonic group and 26±3 min in mannitol group. Conclusion Both hypertonic saline and mannitol have beneifcial effect on hemodynamics and intra-cranial pressure. However, hypertonic saline can increase the cardiac output and TFC and may bring ad-ditional burden to the cardiac and respiratory function.

关 键 词：高渗盐 甘露醇 颅内压 氧合指数 胸腔液体含量 

分 类 号：R614.1[医药卫生—麻醉学]