小儿神经外科术中输注不同浓度含糖液对脑糖代谢的影响

Effect of Different Concentrations of Dextrose Transfusion on Cerebral Glucose Metabolism in Pediatric Neurosurgical Operations

目的:探讨不同浓度含糖液输注在小儿神经外科术中对脑糖代谢的影响。方法:将60例颅脑占位性病变择期手术全身麻醉患儿,随机分为3组:A组术中输注乳酸林格液;B组术中输注2.5%葡萄糖乳酸林格液;C组术中输注1%葡萄糖乳酸林格液。记录麻醉全程患儿血流动力学参数、插管前即刻(Ta)、切开硬脑膜后2h(Tb)和术毕睁眼时(Tc)的血糖及乳酸值,应用微透析技术在切开硬脑膜灌注1h后开始收集微透析液标本,每间隔1h收集1次,应用生化分析仪及相应试剂盒测定切开硬脑膜后1h(TA)和2h(TB)的葡萄糖和乳酸含量。结果:3组患儿心率、平均动脉压和脉搏氧饱和度差异均无统计学意义(均P>0.05)。组间Ta期血糖差异无统计学意义(P>0.05),Tb和Tc期血糖值B组>C组>A组(P<0.01),组内比较各组Tb和Tc期血糖值均大于Ta期(P<0.01)。3组患儿血乳酸值组内及组间比较差异均无统计学意义(均P>0.05)。3组患儿微透析液葡萄糖值和乳酸值组间及组内比较差异均无统计学意义(均P>0.05)。结论:患儿在神经外科手术期间输注乳酸林格液或低浓度含糖液将增加血糖浓度,对血乳酸、脑组织葡萄糖及乳酸值无不利影响,是相对安全的液体选择。

Objective：To investigate the effect of different concentrations of dextrose transfusion on cerebral glucose metabolism in pediatric neurosurgical operations. Methods：Sixty anesthetized children undergoing selective cerebral tumor resection were randomly divided into three groups：Ringer lactate solution group （A,n = 20）,2.5% dextrose lactated Ringer＇s solution group（B,n = 20）,1% dextrose lactated Ringer＇s solution group （C,n = 20）. All the hemodynamic data were recorded during anesthesia. The values of blood glucose and lactic acid were collected before intubation （Ta）,2 hours after opening cerebral dura mater （Tb） and the end of operation （Tc）. The catheters for microdialysis were punctured into normal brain tissue. The contents of glucose and lactic acid were determined in the collected intercellular fluid by biochemical analysis instruments at TA and TB respectively. Results：There were no differences in heart rate（HR）,mean arterial pressure（MAP） and arterial oxygen saturation （SpO2） among three groups（P〉0.05）. There were no differences in blood glucose at Ta between three groups（〉P0.05）. The values of blood glucose at Tb and Tc were B group〉C group〉A group （P〈0.05）. The values of blood glucose were higher at Tb and Tc than that of Ta in three groups（P〈0.05）. There were no differences in blood lactic acid among three groups（P〈0.05）. There were no significant differences in values of glucose and lactic acid in the collected intercellular fluid among three groups （P〈0.05）. Conclusion：Transfusion of Ringer lactate solution or low concentration dextrose solution will increase blood glucose in pediatric neurosurgical operations,but still in the normal range,which has a little influence on blood lactic acid,glucose and lactic acid in brain intercellular fluid. It is a safe choice during neurosurgical operation.