甘露醇对颅脑手术患者脑氧供需平衡的影响

Effect of mannitol on cerebral oxygen supply and consumption in patients undergoing craniotomy

目的 探讨颅脑手术麻醉期间静脉输注甘露醇对脑氧供需平衡的影响。方法 选择静脉全麻下开颅行幕上肿瘤切除术患者 1 4例 ,分别检测静脉输注 2 5 %甘露醇 1 g/kg输注前和输注后 30、60分钟时的颅内压 (ICP) ,颈内静脉和桡动脉的血气 ,计算脑灌注压 (CPP)、动 颈静脉氧含量差 (C (a j) O2 )和脑氧摄取率 (CEO2 )。结果 甘露醇输注后 30分钟 ,ICP和心率 (HR)较输注前显著降低 (P <0 0 5) ;但CPP、C (a j) O2 和CEO2 虽呈下降趋势 ,但与输注前比较均无统计学差异。结论 颅脑手术麻醉期间输注甘露醇 ,不仅可降低ICP ,对MAP和CPP无明显影响 ,而且能改善脑血流代谢耦联 。

Objective To evaluate the effect of mannitol on cerebral oxygen supply and consumption in patients undergoing craniotomy under intravenous anesthesia.Methods Mannitol 1g/kg was administered intravenously with in 15min in fourteen patients underwent craniotomy for supratentorial cerebral tumors.Blood samples were taken from radial artery and internal jugular bulb to determine cerebral arteriovenous oxygen differences (C (a j) O 2) and cerebral oxygen extraction (CEO 2).Intracranial pressure (ICP),C (a j) O 2 and CEO 2 were measured before and at 30min,60min after mannitol infusion.Results ICP and heart rate decreased significantly at 30min after mannitol infusion ( P< 0 05).Although C (a j) O 2 and CEO 2 decreased after mannitol was administrated,mannitol did not affect cerebral perfusion pressure,C (a j) O 2 and CEO 2.Conclusion Infusion of mannitol not only decreases ICP without a negative affec on MAP and CPP but also improves cerebral blood flow metabolism coupling during neurosurgery.This is beneficial to the patients undergoing craniotomy.