等渗透剂量20%甘露醇与3%高渗盐水对大脑半球胶质瘤切除术患者血浆渗透浓度和电解质影响的比较

Effects of equiosmolar load of 3 % saline and 20% mannitol on plasma osmolarity and plasma concentrations of electrolytes： A randomized clinical comparison

目的 比较择期大脑半球胶质瘤切除术中应用等渗透剂量的3%高渗盐水（hypertonie saline,HTS）和20%甘露醇（mannitol,M）降颅内压（intracranial pressure,ICP）的同时,患者血浆渗透浓度和电解质的变化及其临床意义. 方法 择期行大脑半球胶质瘤切除术患者40例,根据计算机随机分组表分为高渗盐水组（HTS组）和甘露醇组（M组）（n=20）.两组均行静吸复合麻醉,异氟醚呼气末浓度达1 MAC后,在15 min内输注等渗透剂量3%HTS（5.33 ml/kg）或20%M（1 g/kg）.记录输注前即刻（T0）、输注后即刻、输注后5、15、30、60、90、120 min（T1～T7）平均动脉压（MAP）、心率（HR）,同时采取5 ml动脉血测定血球压积、血浆Na^＋、K^＋、Cl浓度、血pH、血浆渗透浓度,同时监测颅内压.结果 两组血浆渗透浓度在输注高渗溶液后均明显升高,在T1达高峰[HTS组：（305.1＋4.3）mOsm/L;M组：（304.6±3.5）mOsm/kg]（P〈0.05）,HTS组血浆Na^＋和Cl浓度明显升高,于T1达高峰（152.3＋5.2）mEq/kg（P〈0.05）,M组血浆Na^＋度降低,在T1达低谷（131.2±3.3）mEq/kg（P〈0.05）;血浆Cl-浓度在HTS组升高（P〈0.05）,M组降低（P〈0.05）.HTS组ICP在T2～T5降低（P〈0.05）,尤以T1～T2时段降低幅度更为明显,M组ICP在T3～T5降低（P〈0.05）.结论 在实施择期神经外科手术的患者,单剂静脉输注5.49 mOsm/kg的3%HTS和20%M引起同等程度的血浆渗透浓度上升,并在输注末达到高峰.

Objective 3% saline （HTS） and 20% mannitol （M） are hypertonic solutions used in patients with an increased ICP.The aim of this study was to compare the effects of equiosmolar load of 3% saline and 20% mannitol on plasma osmolarity and plasma concentrations of electrolytes. Methods Forty patients undergoing elective resection of cerebral hemisphere glioma were randomly assigned into two groups （groups HTS and M, n=20 in each group）. Two groups underwent inhalation-intravenous combined anesthesia.After end-tidal concentration of isoflurane reached 1 MAC, an equiosmolar load （5.49 mOsm/L） of solutions of 3% saline （5.33 ml/kg） or 20% mannitol （1 g/kg）was administered intravenously in 15 minutes. The mean arterial pressure, heart rate, arterial blood hematocrit,plasma concentrations of Na^＋ and Cl^-, pH and plasma osmolarity were measured immediately before intravenous infusion and at 0, 5, 15, 30, 60, 90, 120min （T1～T7） after intravenous infusion. Also ICP was monitored. Results After infusion of hypertonic solution, plasma osmolarity significantly increased in both groups [group HTS： （305.1±4.3） mOsm/kg;group M： （304.6±3.5） mOsm/kg, P〈0.05]. The plasma concentrations of Na^＋ and Cl^-significantly increased in group HTS （highest plasma concentrations of Na＋： 152 mEq/L,P〈0.05）. The plasma concentration of Na＋ significantly decreased in group M （lowest coneentration：132 mEq/L）. ICP significantly decreased from T2 to T5 observed time points in group HTS and from T3 to T5 observed time points observed time points in group M（P〈0.05）. Conclusion In the patients undergoing elective neurosurgery, a single intravenous infusion of 5.49 mOsm/kg of 3% saline or 20% mannitol can produce same increases in the plasma osmolality, with a maximal effect at the end of infusion.