3%高渗盐水和20%甘露醇在急诊颅脑外科手术中应用比较

3% hypertonic solution vs. 20% mannitol in neurosurgery for emergency patients

目的比较3%高渗盐水（HTS）和20%甘露醇（M）对急诊手术病人脑脊液压（CSFP）和循环稳定及安全性的影响。方法急诊硬膜外血肿手术病人40例,随机分为HTS和M两组（每组20例）,静吸复合麻醉平稳后,在15min内分别输入3%HTS和20%M。输完后分别于输注完即刻（T0）、15min（T1）、30min（T2）、60min（T3）、90min（T4）、120min（T5）检测心排量（CO）、心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、CSFP、尿量,计算脑灌注压（CPP）。取桡动脉血监测血Na＋、K＋、Cl-、BUN、Glu,计算血浆渗透压。结果两组各时点HR、Na＋、血浆渗透压差异无显著性。M组T3~T4时段CVP、MAP显著降低,T3~T5时段K＋显著降低,T2~T5时段尿量高于HTS组（P均〈0.01）。结论急诊颅脑外伤手术中,3%HTS与20%M在降颅压方面效果相当,但在循环稳定和防止电解质紊乱方面3%HTS更具有优势。

Objective To compare the effects of 3% hypertonic solution （HTS） to 20% mannitol （M） on the cerebrospinal fluid pressure （CSFP） and the circulation stability in emergency patients undergoing neurosurgery. Methods Forty patients with epidural hematoma undergoing emergency surgery were randomly allocated to HTS group and M group （20 cases in each group）. When the patients was smooth after combined inhalation and intravenous anesthesia, the patients were given intravenous injection with 396 FITS and 2096 M within 15 min, respectively. After injection, the cardiac output （CO）, heart rate （HR）, mean arterial pressure （MAP）, central venous pressure （CVP）, CSFP and urine volume were detected at the end of injection （To）, 15min （T1）, 30min （T2）, 60min （T3）, 90min （T4） and 120min （T5）, then the cerebral perfusion pressure （CPP） was calculated. The radial artery blood was collected for measuring the levels o.t blood Na^＋ , K^＋ , Cl^-, BUN and Glu, the plasma osmotic pressure was calculated. Results Compared between these two groups, the levels of blood Na^＋ , HR and plasma osmotic pressure were almost the same, there was no significant difference at every time. In M group, at T3-T4, the levels of CVP and MAP decreased significantly; at T3-T5, the level of K^= reduced significantly; at T2-T5, the volume of urine was higher than FITS group （ P 〈0.01）. Conclusion In emergency neurosurgery, 3 % HTS and 20% M has the same effects on intracranial decompression, but in maintaining circulation stability and preventing electrolyte disorder, 3% HTS is superior to 20% M.