羟乙基淀粉在开颅血肿清除术中的早期应用探讨

Cerebral protective effect of early admission with hydroxyethylstarch during the decompressive craniectomy

目的探讨开颅血肿清除术中早期快速输注羟乙基淀粉对去颅骨瓣后反射性低血压的预防作用。方法将40例开颅血肿清除术患者随机分为两组,均使用气管内全身麻醉。A组（对照组）在入室后到去颅骨瓣前单纯输注乳酸钠林格注射液750 ml;B组（实验组）在入室后到去颅骨瓣前输入羟乙基淀粉500 ml、乳酸钠林格注射液250 ml。去颅骨瓣减压后根据患者情况输入羟乙基淀粉或浓缩红细胞及晶体液。观察两组患者诱导前、去颅骨瓣前和去颅骨瓣后5 min、15 min的收缩压（SBP）、舒张压（DBP）、中心静脉压（CVP）、HR及手术后存活率。结果麻醉诱导前A组SBP、DBP、CVP、HR与B组无明显差异,去颅骨瓣前两组SBP、DBP均有下降,但两组之间无明显差异,CVP值B组高于A组。去颅骨瓣后5 min两组SBP、DBP均明显下降,但B组较A组平缓（P＜0．05）,两组HR无明显差异。去颅骨瓣后15 min,A组和B组SBP、DBP均有回升．B组SBP回升明显比A组高（P＜0．01）。CVP值在去颅骨瓣后5 min、15 min B组明显高于A组（P＜0．05）。手术后存活率A组68%,B组90%。结论去颅骨瓣前用羟乙基淀粉联合乳酸钠林格注射液快速扩容可以有效预防去颅骨瓣后血压反射性骤降,防止脑组织的进一步缺血、缺氧。

Objective To investigate the value for the prevention of reflexive hypotention with the rapid infusion of hydroxyethylstarch （6% HES） during the decompressive craniectomy. Methods Forty patients with craniecromy undergoing general anesthesia were divided randomly into 2 groups, group A（contrast group, n = 19） ： only 750ml of lactated Ringer＇s solution were given intravenously between the time of entering operating room and of craniectomy; Group B（ treatment group, n = 21 ） ： 500ml of hydroxyethylstarch and 250ml of lactated Ringer＇ s solution were infused, Hydroxyethylstarch,concentrated red cell or crystalloid fluids were given respectively according to the patient＇s needs. The time of before induction, of pre-craniectomy 5,15 minutes of pos〉craniectomy, SBP, DBP, CVP,HR and survival rate were recorded respectively. Results SBP, DBP,CVP, HR of two groups had no signifb cant difference before induction. SBP and DBP were declined, but it had no difference between two group, CVP of group B was higher than of group A before craniectomy, 5 minutes after cranietomy, SBP and DBP of two groups greatly declined, group B declined slower than group A（P 〈 0.05）, HR had no difference. 15 minutes after cranietomy, SBP and DBP of two groups increased, SBP of group B increased apparently （P 〈 0.01 ）. The survival rates of group A and B were 68 %, 90%. Conclusion Rapid expanding blood volume of hydroxyethylstarch and lactated Ringer＇s solution before craniotomy could be effective prevention of reflexive hypotention after cranioromy,avoid the further hypoxia and ischemia of brain tissues.