国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2010年
4期
294-297
,共4页
盐水,等渗%甘露醇%血浆渗透浓度%电解质
鹽水,等滲%甘露醇%血漿滲透濃度%電解質
염수,등삼%감로순%혈장삼투농도%전해질
Saline Salution,Hypertonic%Mannitol%Osmolarity%Electrolytes
目的 比较择期大脑半球胶质瘤切除术中应用等渗透剂量的3%高渗盐水(hypertonie saline,HTS)和20%甘露醇(mannitol,M)降颅内压(intracranial pressure,ICP)的同时,患者血浆渗透浓度和电解质的变化及其临床意义. 方法 择期行大脑半球胶质瘤切除术患者40例,根据计算机随机分组表分为高渗盐水组(HTS组)和甘露醇组(M组)(n=20).两组均行静吸复合麻醉,异氟醚呼气末浓度达1 MAC后,在15 min内输注等渗透剂量3%HTS(5.33 ml/kg)或20%M(1 g/kg).记录输注前即刻(T0)、输注后即刻、输注后5、15、30、60、90、120 min(T1～T7)平均动脉压(MAP)、心率(HR),同时采取5 ml动脉血测定血球压积、血浆Na+、K+、Cl浓度、血pH、血浆渗透浓度,同时监测颅内压.结果 两组血浆渗透浓度在输注高渗溶液后均明显升高,在T1达高峰[HTS组:(305.1+4.3)mOsm/L;M组:(304.6±3.5)mOsm/kg](P<0.05),HTS组血浆Na+和cl浓度明显升高,于T1达高峰(152.3+5.2)mEq/kg(P<0.05),M组血浆Na+度降低,在T1达低谷(131.2±3.3)mEq/kg(P<0.05);血浆Cl-浓度在HTS组升高(P<0.05),M组降低(P<0.05).HTS组ICP在T2～T5降低(P<0.05),尤以T1～T2时段降低幅度更为明显,M组ICP在T3～T5降低(P<0.05).结论 在实施择期神经外科手术的患者,单剂静脉输注5.49 mOsm/kg的3%HTS和20%M引起同等程度的血浆渗透浓度上升,并在输注末达到高峰.
目的 比較擇期大腦半毬膠質瘤切除術中應用等滲透劑量的3%高滲鹽水(hypertonie saline,HTS)和20%甘露醇(mannitol,M)降顱內壓(intracranial pressure,ICP)的同時,患者血漿滲透濃度和電解質的變化及其臨床意義. 方法 擇期行大腦半毬膠質瘤切除術患者40例,根據計算機隨機分組錶分為高滲鹽水組(HTS組)和甘露醇組(M組)(n=20).兩組均行靜吸複閤痳醉,異氟醚呼氣末濃度達1 MAC後,在15 min內輸註等滲透劑量3%HTS(5.33 ml/kg)或20%M(1 g/kg).記錄輸註前即刻(T0)、輸註後即刻、輸註後5、15、30、60、90、120 min(T1～T7)平均動脈壓(MAP)、心率(HR),同時採取5 ml動脈血測定血毬壓積、血漿Na+、K+、Cl濃度、血pH、血漿滲透濃度,同時鑑測顱內壓.結果 兩組血漿滲透濃度在輸註高滲溶液後均明顯升高,在T1達高峰[HTS組:(305.1+4.3)mOsm/L;M組:(304.6±3.5)mOsm/kg](P<0.05),HTS組血漿Na+和cl濃度明顯升高,于T1達高峰(152.3+5.2)mEq/kg(P<0.05),M組血漿Na+度降低,在T1達低穀(131.2±3.3)mEq/kg(P<0.05);血漿Cl-濃度在HTS組升高(P<0.05),M組降低(P<0.05).HTS組ICP在T2～T5降低(P<0.05),尤以T1～T2時段降低幅度更為明顯,M組ICP在T3～T5降低(P<0.05).結論 在實施擇期神經外科手術的患者,單劑靜脈輸註5.49 mOsm/kg的3%HTS和20%M引起同等程度的血漿滲透濃度上升,併在輸註末達到高峰.
목적 비교택기대뇌반구효질류절제술중응용등삼투제량적3%고삼염수(hypertonie saline,HTS)화20%감로순(mannitol,M)강로내압(intracranial pressure,ICP)적동시,환자혈장삼투농도화전해질적변화급기림상의의. 방법 택기행대뇌반구효질류절제술환자40례,근거계산궤수궤분조표분위고삼염수조(HTS조)화감로순조(M조)(n=20).량조균행정흡복합마취,이불미호기말농도체1 MAC후,재15 min내수주등삼투제량3%HTS(5.33 ml/kg)혹20%M(1 g/kg).기록수주전즉각(T0)、수주후즉각、수주후5、15、30、60、90、120 min(T1～T7)평균동맥압(MAP)、심솔(HR),동시채취5 ml동맥혈측정혈구압적、혈장Na+、K+、Cl농도、혈pH、혈장삼투농도,동시감측로내압.결과 량조혈장삼투농도재수주고삼용액후균명현승고,재T1체고봉[HTS조:(305.1+4.3)mOsm/L;M조:(304.6±3.5)mOsm/kg](P<0.05),HTS조혈장Na+화cl농도명현승고,우T1체고봉(152.3+5.2)mEq/kg(P<0.05),M조혈장Na+도강저,재T1체저곡(131.2±3.3)mEq/kg(P<0.05);혈장Cl-농도재HTS조승고(P<0.05),M조강저(P<0.05).HTS조ICP재T2～T5강저(P<0.05),우이T1～T2시단강저폭도경위명현,M조ICP재T3～T5강저(P<0.05).결론 재실시택기신경외과수술적환자,단제정맥수주5.49 mOsm/kg적3%HTS화20%M인기동등정도적혈장삼투농도상승,병재수주말체도고봉.
Objective 3% saline (HTS) and 20% mannitol (M) are hypertonic solutions used in patients with an increased ICP.The aim of this study was to compare the effects of equiosmolar load of 3% saline and 20% mannitol on plasma osmolarity and plasma concentrations of electrolytes. Methods Forty patients undergoing elective resection of cerebral hemisphere glioma were randomly assigned into two groups (groups HTS and M, n=20 in each group). Two groups underwent inhalation-intravenous combined anesthesia.After end-tidal concentration of isoflurane reached 1 MAC, an equiosmolar load (5.49 mOsm/L) of solutions of 3% saline (5.33 ml/kg) or 20% mannitol (1 g/kg)was administered intravenously in 15 minutes. The mean arterial pressure, heart rate, arterial blood hematocrit,plasma concentrations of Na+ and Cl-, pH and plasma osmolarity were measured immediately before intravenous infusion and at 0, 5, 15, 30, 60, 90, 120min (T1～T7) after intravenous infusion. Also ICP was monitored. Results After infusion of hypertonic solution, plasma osmolarity significantly increased in both groups [group HTS: (305.1±4.3) mOsm/kg;group M: (304.6±3.5) mOsm/kg, P<0.05]. The plasma concentrations of Na+ and Cl-significantly increased in group HTS (highest plasma concentrations of Na+: 152 mEq/L,P<0.05). The plasma concentration of Na+ significantly decreased in group M (lowest coneentration:132 mEq/L). ICP significantly decreased from T2 to T5 observed time points in group HTS and from T3 to T5 observed time points observed time points in group M(P<0.05). Conclusion In the patients undergoing elective neurosurgery, a single intravenous infusion of 5.49 mOsm/kg of 3% saline or 20% mannitol can produce same increases in the plasma osmolality, with a maximal effect at the end of infusion.
