高渗氯化钠羟乙基淀粉40对脑胶质瘤手术患者颅内压及脑氧供需平衡的影响

Effect of hypertonic sodium chloride hydroxyethyl starch 40 injection on intracranial pressure and cerebral oxygen supply and consumption in patients undergoing cerebral glioma operation

目的观察高渗氯化钠羟乙基淀粉40注射液(HSS40)对脑胶质瘤手术患者颅内压及脑氧供需平衡的影响。方法对15例脑胶质瘤患者于全麻下行大脑半球胶质瘤切除术,麻醉后15 min内静滴完毕HSS40 5 ml/kg。监测静滴前即刻(T0)及静滴后153、0、60、90 min(T1～T4)平均动脉压(MAP)、呼气末二氧化碳(PETCO2),并记录血红蛋白(Hb)、动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、动脉血血红蛋白(Hba)、颈内静脉血氧分压(Pj-vO2)、颈内静脉血血红蛋白(Hbjv)、颈内静脉血氧饱和度(SjvO2)值。根据Fick公式分别计算动脉血氧含量(CaO2)、颈静脉球血氧含量(CjvO2)、动—颈内静脉血氧含量差[C(a-j)O2]及脑氧摄取率(CERO2)。结果 T2、T3、T4时点CSFP水平明显低于T0,T3、T4时点C(a-j)O2、CERO2水平明显低于T0,P均<0.05。结论 HSS40能够持久有效地降低颅内压,改善脑组织氧供及氧需平衡。

Objective To evaluate the effect of hypertonic sodium chloride hydroxyethyl starch 40 injection on in- tmcranial pressure and cerebral oxygen supply and consumption in patients undergoing cerebral glioma operation. Methods 15 patients were subjected to operative excision of supratentorial gliomata. After induetion of general anesthesia, HSS40 5 ml/kg was infused ivgtt within 15 rain. At the moment before ivgtt （T0）and 15,30,60,90 rain after（T1 -T4） the MAP and PETCO2 were recorded, Hb, PaO2, SaO2, Hba, PjvO2, Hbjv and SjvO2 were detected, CaO2, CjvO2 ,cerebral arteriove- nous oxygen differences [ C （a-j） 02 ] and cerebral oxygen extraction （ CERO2 ） were calculated accord to Fick formula. Resuits As compared with their baseline values at To, CSFP was significantly decreased at T2 ,T3 ,T4, C（a-j） O2 and CERO2 decreased at T1- T4, especially in T3 andT4, all P 〈 0.05. Conclusions Infusion of HSS40 can not only decreases intraeranial pressure but also improves cerebral oxygen supply and consumption in patients undergoing cerebral glioma operation.