CAJ | 학술논문

目的观察颅内高压患者术中应用3％高渗盐水(HS)与20％甘露醇(M)的血流动力学及内环境的变化.方法 60例颅内高压患者随机分为HS组(n=30)和M组(n=30),观察开始用药时(T0)、用药后(T1)、5 min( T2)、15 min(T3)、30 min( T4)、45 min(T5)、60 min( T6)、90 min (T7)、120 min( T8)的心率(HR)、平均动脉压(MAP)、每搏量指数(SVI)、每搏量变异度(SVV)、中心静脉压(CVP)、体循环血管阻力指数(SVRI)和尿量,T0、T8时点桡动脉血pH值、Na+、K+、Ca2、血乳酸(BLA).结果 (1)HS组:与T0比较,输注后T1～T8时点SVV降低,SVI、CVP、MAP值升高(P＜0.05)；HR值T1时点升高,T6～T8时点降低(P＜0.05)；SVRI值T1～T5时点降低(P＜0.05).(2)与T0比较,HS组T8时点Na+值升高,BLA值降低(P＜0.05)；两级比较,T8时点组间Na+值比较差异有统计学意义(P＜0.05).(3)与M组比较,T5～T8时点SVV、SVI、CVP、MAP、HR、SVRI差异有统计学意义(P＜0.05).(4)各时点M组尿量多于HS组(P＜0.05).结论颅内高压患者术中输注3％ HS在维持血流动力学稳定和改善内环境方面优于20％M.
목적 관찰로내고압환자술중응용3％고삼염수(HS)여20％감로순(M)적혈류동역학급내배경적변화.방법 60례로내고압환자수궤분위HS조(n=30)화M조(n=30),관찰개시용약시(T0)、용약후(T1)、5 min( T2)、15 min(T3)、30 min( T4)、45 min(T5)、60 min( T6)、90 min (T7)、120 min( T8)적심솔(HR)、평균동맥압(MAP)、매박량지수(SVI)、매박량변이도(SVV)、중심정맥압(CVP)、체순배혈관조력지수(SVRI)화뇨량,T0、T8시점뇨동맥혈pH치、Na+、K+、Ca2、혈유산(BLA).결과 (1)HS조:여T0비교,수주후T1～T8시점SVV강저,SVI、CVP、MAP치승고(P＜0.05)；HR치T1시점승고,T6～T8시점강저(P＜0.05)；SVRI치T1～T5시점강저(P＜0.05).(2)여T0비교,HS조T8시점Na+치승고,BLA치강저(P＜0.05)；량급비교,T8시점조간Na+치비교차이유통계학의의(P＜0.05).(3)여M조비교,T5～T8시점SVV、SVI、CVP、MAP、HR、SVRI차이유통계학의의(P＜0.05).(4)각시점M조뇨량다우HS조(P＜0.05).결론 로내고압환자술중수주3％ HS재유지혈류동역학은정화개선내배경방면우우20％M.
Objective To observe the changes in hemodynamics and internal environments after application of 3％ hypertonic saline (HS) vs 20％ mannitol (M) in intracranial hypertensive patients.Methods Sixty patients with intracranial hypertension were randomly allocated to HS group (n =30) and M group (n =30),receiving 3％ HS and 20％ M respectively.Heart rate ( HR),mean arterial pressure (MAP),stroke volume index (SVI),stroke volume variation (SVV),central venous pressure (CVP),systemic vascular resistance index ( SVRI ) and urine output were measured before injection (T0 ),immediate (T1),5 min (T2),15 min (T3),30 min (T4),45 min (T5),60 min (T6),90 min (T7),and 120 min (T8 ) after injection.The radial artery blood was collected for measuring the pH,Na+,K+,Ca2+,blood lactate (BLA) at T0 and T8.Results ( 1 ) In HS group,the levels of SVV were decreased,and those of SVI,CVP and MAP increased at F1 -T8 as compared with T0 ( P ＜ 0.05 ) ; HR was increased at T1 and decreased at T6-T8 (P ＜ 0.05 ); SVRI was decreased at T1-T5 (P＜0.05 ); (2) As compared with T0,the levels of blood Na + were increased and BLA contents decreased at T8 in HS group ( P ＜ 0.05 );(3) There was significant difference in the levels of SVV,SVI,CVP,MAP,HR and SVRI between HS group at T5-T8 and M group ( P ＜0.05 ) ; (4) The hydrouria in M group at T1-T8 was greater than in HS group (P＜0.05).Conclusions 3％ HS is superior to 20％ M in maintaining circulation stability and improving internal environments during operation in patients with intracranial hypertension.