FloTrac/Vigileo监测快速输注甘露醇对神经外科患者血流动力学参数的影响

Effects of rapid infusion mannitol on hemodynamic parameters using FloTrac /Vigileo monitoring in patients undergoing neurosurgery

目的 观察FloTrac/Vigileo监测下静脉快速输注甘露醇对神经外科手术患者血流动力学参数的影响.方法 择期行幕上肿瘤切除术患者30例.麻醉前行桡动脉穿刺置管,连接FloTrac/Vigileo系统监测血流动力学参数：心指数（CI）、每博量指数（sVI）、平均动脉压（MAP）和每搏量变异度（SVV）的变化.所有患者均于钻颅骨时给予20％甘露醇250 mL,15 min内输注完毕.记录输注甘露醇前5 min（T0）及甘露醇输注完毕10（T1）、15（T2）、20（T3）、25（T4）、30（T5）、35（T6）、40（T7）、45（T8）、50（T9）、55（T10）和60 min（T11）时CI、SVI、SVV、MAP和心率（HR）的变化.结果 与T0比较,T1,T10时点CI值增加（P＜0.05）,T11时点与T0比较差异无统计学意义（P＞0.05）.与T0比较,T1 ～ T10时点SVI升高（P＜0.05）,T11时点与T0比较差异无统计学意义（P＞0.05）.与T0比较,各时点SVV、MAP和HR差异无统计学意义（P＞0.05）.结论 甘露醇静脉快速输注后CI和SVI明显增加,在输注后60 min回到输注前水平,而不影响SVV预测液体反应的能力.

Objective To observe the influences of rapid infusion of mannitol on hemodynamic parameters with FloTrac/Vigileo system in patients undergoing neurosurgery.Methods Thirty patients undergoing elective suprat entorial tumor resection（male 12,female 18）.Before the induction of general anesthesia,radial arterial catheter was connected with FloTrac/Vigileo transducer to monitor hemodynamic parameters of cardiac index （CI）,stroke volume index（SVI）,mean arterial pressure（MAP） and stroke volume variation（SVV）.A 250 mL bolus of 20％ mannitol was administered （in 15 min） at drilling skull.CI,SVI,MAP,HR and SVV were recorded at 5 min before infusion of mannitol and at 10 （T1）,15 （T2）,20 （T3）,25 （T4）,30 （T5）,35 （T6）,40 （T7）,45 （T8）,50 （T9）,55 （T10） and 60 min （T11） after rapid infusion of mannitol.Results CI and SVI were significantly higher at T1 ～ T10 than T0 （P ＜ 0.05）.There was no significant difference in MAP,HR and SVV values at different time points （P ＞ 0.05）.Conclusion Hemodynamic parameters of CI and SVI obviously increase after rapid infusion mannitol,and recover at 60 min after infusion mannitol.The SVV as predictive indicator of fluid response is not affected by mannitol infusion.