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目的观察3%高渗盐水(HTS)对颅内肿瘤患者脑脊液压力(CSFP)、血液动力学及电解质的影响,探讨3%HTS用于降低颅内肿瘤患者颅内压的可行性。方法择期行大脑半球胶质瘤切除术患者加例,男23例,女17例,ASA Ⅰ或Ⅱ级,随机分为两组(n=20),HTS组和M组,麻醉诱导前行L3,4刺置管监测CSFP。两组均行静吸复合麻醉,异氟醚呼气末浓度达1MAC后,在15 min内输注3%HTS(5.33 ml/kg)和20%甘露醇(1g/kg)。在输注前即刻(T0)、输注后15、30、60、90、120 min(T1-5)记录平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、尿量,采集5 ml动脉血测定血浆Na+、K+、pH、血浆渗透压;在T0-4监测CSFP,计算脑灌注压(CPP)。结果两组各时点MAP和HR比较差异无统计学意义(P>0.05)。与T0时比较,HTS组CSFP在T2-4时降低,M组在T3、T4时降低,HTS组CVP在T1-4 时升高,M组在T4、T5时降低,两组各时点血浆渗透压均升高,两组不同时点血浆Na+和K+浓度均有改变但仍在正常范围内(P<0.05)。与M组比较,HTS组CSFP在T2时降低,CVP在T5时升高,尿量在T1-2、T2-3、T3-4、T4-5时段减少(P<0.05)。结论3%HTS可安全地用于颅内肿瘤患者,其降低颅内压的作用优于20%甘露醇,且在降低颅内压的同时,不影响血液动力学。
Objective To investigate the effect of 3% HTS on cerebrospinal fluid pressure (CSF), hemodynamics and electrolytes in patients with intracranial tumors and to explore the feasibility of 3% HTS in reducing intracranial pressure in patients with intracranial tumors. Methods Thirty-nine patients were male, 17 were female, ASA Ⅰ or Ⅱ were randomly divided into two groups (n = 20), HTS group and M group, 4 Prostate tube monitors CSFP. Both groups were treated with inhalation anesthesia, 3% HTS (5.33 ml / kg) and 20% mannitol (1 g / kg) were infused within 15 minutes after inhalation of isoflurane. The mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), urine output, and blood pressure were recorded immediately before infusion (T0), 15,30,60,90 and 120 min after infusion (T1-5) Collect 5 ml arterial blood to measure plasma Na +, K +, pH and plasma osmolality. Monitor CSFP at T0-4 and calculate cerebral perfusion pressure (CPP). Results There was no significant difference in MAP and HR between the two groups at each time point (P> 0.05). Compared with T0, CSF in HTS group decreased at T2-4, decreased at T3 and T4 in HT group, CVP increased at T1-4 in HTS group, decreased at T4 and T5 in HT group, The osmotic pressure increased at different time points, and both plasma Na + and K + concentrations changed at different time points but remained within the normal range (P <0.05). Compared with M group, CSFP in HTS group decreased at T2 and CVP increased at T5, while urine volume decreased at T1-2, T2-3, T3-4 and T4-5 (P <0.05). Conclusions 3% HTS is safe for use in patients with intracranial tumors and its effect of lowering intracranial pressure is superior to that of 20% mannitol, with no effect on hemodynamics while reducing intracranial pressure.