中国血液流变学杂志
中國血液流變學雜誌
중국혈액류변학잡지
CHINESE JOURNAL OF HEMORHEOLOGY
2013年
4期
657-660
,共4页
高渗盐%甘露醇%颅内压%氧合指数%胸腔液体含量
高滲鹽%甘露醇%顱內壓%氧閤指數%胸腔液體含量
고삼염%감로순%로내압%양합지수%흉강액체함량
hypertonic saline%mannitol%intra-cranial pressure%oxygenation index%thoracic lfuid content
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。
目的：觀察高滲鹽溶液對神經外科手術患者血流動力學和呼吸功能的影響。方法60例擬行擇期神經外科開顱手術的患者（18～65歲），隨機分為高滲鹽組和甘露醇組，高滲鹽組所有患者在痳醉誘導後30 min內給與3%氯化鈉溶液500 mL，對照組誘導後30 min內給與20%甘露醇500 mL，後兩組患者輸入乳痠林格液5 mL?kg-1?h-1。鑑測平均動脈壓（MAP）、心率（HR）、心排量（CO）、胸腔液體含量（TFC）和氧閤指數（OI），同時觀察硬腦膜張力、齣血量、尿量、手術時間和拔管時間。結果與基礎值相比，兩組患者MAP和CO在痳醉誘導後顯著降低，後逐漸升高，且高滲鹽組更持久。與基礎值相比，兩組患者TFC和OI無明顯改變，甘露醇和高滲鹽均能顯著地增加TFC和降低OI，甘露醇組在術畢恢複。高滲鹽組具有更好的降低硬腦膜張力的作用。高滲鹽組尿量為355±42 mL，而甘露醇組為680±59 mL。高滲鹽組拔管時間為38±4 min，而甘露醇組為26±3 min。結論甘露醇和高滲鹽都具有很好的穩定血流動力學和降低顱內壓的作用，但是高滲鹽可顯著增加心排量和胸腔液體含量。
목적：관찰고삼염용액대신경외과수술환자혈류동역학화호흡공능적영향。방법60례의행택기신경외과개로수술적환자（18～65세），수궤분위고삼염조화감로순조，고삼염조소유환자재마취유도후30 min내급여3%록화납용액500 mL，대조조유도후30 min내급여20%감로순500 mL，후량조환자수입유산림격액5 mL?kg-1?h-1。감측평균동맥압（MAP）、심솔（HR）、심배량（CO）、흉강액체함량（TFC）화양합지수（OI），동시관찰경뇌막장력、출혈량、뇨량、수술시간화발관시간。결과여기출치상비，량조환자MAP화CO재마취유도후현저강저，후축점승고，차고삼염조경지구。여기출치상비，량조환자TFC화OI무명현개변，감로순화고삼염균능현저지증가TFC화강저OI，감로순조재술필회복。고삼염조구유경호적강저경뇌막장력적작용。고삼염조뇨량위355±42 mL，이감로순조위680±59 mL。고삼염조발관시간위38±4 min，이감로순조위26±3 min。결론감로순화고삼염도구유흔호적은정혈류동역학화강저로내압적작용，단시고삼염가현저증가심배량화흉강액체함량。
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.
