高渗氯化钠羟乙基淀粉40注射液对脑肿瘤患者术中葡萄糖摄取率和静动脉乳酸差的影响

Effects of hypertonic sodium chloride hydroxythel starch 40 injection on cerebral glucose extraction rate and V-A lactic acid difference of cerebral tumor patients

目的:观察高渗氯化钠羟乙基淀粉40注射液(HH40)对脑肿瘤患者葡萄糖摄取率和静动脉乳酸差的影响.方法:ASAI～II级颅内肿瘤患者行择期开颅手术60例,随机分为3组(n=20),HH404mL/kg组(HH40A组)、HH402mL/kg组(HH40B组)、200mL/L甘露醇4mL/kg组(M组).常规麻醉诱导,七氟烷呼气末浓度达1.2最低有效肺泡气浓度(MAC)后,在15min内静脉滴注各组实验液体.在静滴前即刻(T0)、静滴后15,30,60,120min(T1～T4)记录平均动脉压(MAP)、心率(HR)、中心静脉压(CVP),并抽取桡动脉和颈静脉球血行血气分析及乳酸测定.结果:3组各时点MAP和HR比较差异无显著意义.HH40A组的葡萄糖摄取率较HH40B组和200mL/L甘露醇组低,其中于T1～T4时间点与200mL/L甘露醇组比较有统计学意义(P<0.05),于T2～T4时间点与HH40B组比较有统计学意义(P<0.05).HH40A组的静动脉乳酸差较200mL/L甘露醇组低,于T1～T4时间点有显著统计学意义(P<0.05).HH40A组与HH40B组无明显差异,但HH40B组亦较200mL/L甘露醇组低,且于T1～T4有统计学意义(P<0.01).结论:高渗氯化钠羟乙基淀粉40注射液用于脑肿瘤切除术可降低葡萄糖摄取率,减少无氧代谢乳酸生成,改善脑氧代谢,其效果优于相同剂量的甘露醇.

AIM：To observe the effect of hypertonic sodium chloride hydroxythel starch 40 injection（HH40） on Cerebral glucose extraction rate and V-A lactic acid difference of cerebral tumor patients.METHODS：Sixty ASAI-II patients with cerebral tumor undergoing elective craniotomy were randomly divided into three groups：Group HH40 A（HH40 4 mL/kg）,Group HH40 B（HH40 2 mL/kg） and Group M（mannitol 4 mL/kg）.All patients were accepted general anesthesia.After the exhalant concentration of sevoflurane reached 1.2 MAC,experimental fluid were dripped within 15 min.The MAP,HR and CVP were monitored before the infusion（T0） and 15,30,60,120 min after the infusion（T1-T4）.Blood samples were collected from bulbus venae jugularis and radial artery at five time points to make blood gas analysis.RESULTS：There is no significant difference in MAP,HR and CVP.The Cerebral glucose extraction rate of HH40A group is lower than HH40B and mannitol group.There is significant difference between HH40A group and mannitol group at T1-T4 time points,between HH40A group and HH40B group at T2-T4 time points.V-A lactic acid difference of HH40A group is lower than mannitol group.There is significant difference between HH40A group and mannitol group at T1-T4 time points.HH40A group and HH40B group have no significate difference.CONCLUSION：HH40 can degrade cerebral glucose extraction rate and reduce V-A lactic acid difference.It outstrips mannitol on decreasing oxygen metabolism.