3%高渗盐水复合琥珀明胶液用于脑动脉瘤破裂夹闭术

Application of 3% Hypertonic Saline Combined with Succinylated Gelatin in the Clipping of Cerebral Aneurysm

目的:探讨在脑动脉瘤破裂夹闭术中应用3%高渗盐液复合琥珀明胶的可行性。方法:30例经全脑血管造影确诊的脑动脉瘤破裂患者随机分成3组,每组各10例,分别在手术消毒时经右侧颈内静脉输入20%甘露醇(M组)1g.kg-1、3%高渗盐水(M1组)5.35mL.kg-1及3%高渗盐水5.35mL.kg-1复合等容量琥珀明胶(M2组)。在输注前即刻(T0)、输注后15min(T1)、30min(T2)、60min(T3)、90min(T4)、120min(T5)检测并记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、尿量和脑脊液压力(CSFP),同时采集左桡动脉血做血气分析,检测并记录血浆Na+、K+浓度。脑灌注压(CPP)为MAP与CS-FP之差。结果:3组患者的CSFP与T0时比较均有下降,幅度以M2>M1>M。M1组、M2组CVP在T1～5时升高,幅度以M2>M1,而M组在T1～5时降低。3组患者的脑灌注压各时点差别无统计学意义。3组的血浆Na+和K+浓度变化均在正常范围。3组在各时段的尿量M2<M1<M。结论:3%高渗盐水复合琥珀明胶应用于脑动脉瘤破裂夹闭术安全可行。

Objective：To explore the feasibility and application of 3% hypertonic saline succinylated gelatin solution in the clipping of ruptured cerebral aneurysm. Methods：Thirty patients with ruptured intracranial aneurysms were assigned and randomly divided into three groups, 20% Mannitol 1g·kg^-1 （M group）, 3% bypertonic saline 5.35 mL·kg^-1（M1 group） , 3% bypertonic saline 5.35 mL·kg^-1 and equal volume succinylated gelatin solution group （M2 group） Each grap was enrolled 10 patierts. At the time of tbe infusion （T0）, after infusion 15min（ T1 ）, 30 min （ T2 ）, 60 min （ T3 ）, 90 min （T4） and 120 min （ T5 ）. Check and record the heart rate （HR）.mean arterial pressure （MAP）.central vein pressure （CVP）. urine volume and cerebro spinal fluid pressure （CSFP）. Collect the blood of left radial artery at the same time, to make blood gas analysis, detection and record the concentration of Na^＋ .K^＋ in the blood plasma. Subtract CSEP from MAP and you have cerebral perfusion pressure （CPP）. Results： CSFP in To all descended in three groups, the range were M2〉M1 〉M0 M1 and M2＇s CVP at T1-5 steps up, the range was M2 〉M1. But M group at T1-5 falls down. There was no senses in statistics for the difference of the three patients CPP at every time point. The three groups＇ change for blood concentration of Na^＋ and K^＋ were all in the normal limits. Their urine volume at every time point was M2〈M1 〈 M. Conclusion： Application of 3% bypertonic saline succinylated gelatin solution in the clipping of ruptured cerebral aneurysm that is feasible and safe.