目标导向液体治疗在择期神经外科手术中对颅内压和脑氧供需平衡的影响

Effects of Goal-directed Volume Therapy on the Intracranial Pressure and the Balance of Cerebral Oxygen Consumption and Supply in Selective Neurosurgery

目的观察目标导向液体治疗在择期神经外科手术中对颅内压和脑氧供需平衡的影响。方法选择择期全麻下行开颅肿瘤切除术的患者24例,随机分为2组:常规输液组(C组,n=12)和目标导向液体治疗组(G组,n=12)。C组按经典输液方案进行术中液体管理;G组在Flortrac/Vigileo系统监测下,以每搏量变异度(SVV)为导向行液体治疗。分别于麻醉诱导前(T1)、气管插管即刻(T2)、切开硬脑膜时(T3)、切开硬脑膜后1h(T4)、术毕(T5)记录平均动脉压(MAP)、心率(HR)、心输出量指数(CI)、颅内压(ICP)、SVV、颈静脉球血氧饱和度(SjvO2),并计算脑氧摄取率(CERO2),同时记录手术时间、晶体液量、胶体液量、输血量、尿量及出血量。结果与C组比较,G组患者尿量、术中胶体液量及液体总量均增加(均P<0.05)。T4、T5时点G组的MAP、CI均高于C组,且SjvO2增高、CERO2下降(均P<0.05)。与C组比较,G组ICP各时点差异无统计学意义(P>0.05)。结论目标导向液体治疗能够优化心脏前负荷,不增加颅内压,改善脑氧供需平衡。

Objective To investigate the effects of goal‐directed volume therapy （GDVT ）on the intracranial pressure（ICP） and the balance of cerebral oxygen consumption and supply in selective neurosurgery. Methods Twenty‐four patients sched‐uled for intracranial tumor resection were randomly divided into 2 groups：conventional fluid management group （group C ,n=12） and GDVT group（group G ,n=12）. Patients in group C received introperative fluid transfusion according to classical fluid management strategies while those in group G received GDT according to stroke volume variation （SVV） ,guided by Flotrac‐Vigileo system.Mean arterial pressure（MAP） ,heart rate（HR） ,cardiac index（CI） ,ICP ,SVV and jugular bulb oxygen saturation （SjvO2 ）were recorded before the anesthesia induction（T1 ） ,at the moment of intubation（T2 ） ,at the moment of opening the hard meninges（T3）,1hafteropeningthehardmeninges（T4）,andattheendofthesurgery（T5）.Thecerebraloxygenextractionra‐tio（CERO2 ）was calculated. The duration of surgery ,crystalloid volume ,colloid volume ,blood transfusion volume ,urinary output and bleeding volume were recorded as well.Results The colloid transfusion volume ,the total fluid transfusion volume and uri‐nary output were significantly increased in group G when compared with those in group C （P〈0.05）.MAP ,CI ,and SjvO2 were much higher and CERO2 were much lower at T4 and T5 in group G than in group C（P〈0.05）. There was no significant differ‐ence in the ICP at each time point between groups G and C （P〉0.05）.Conclusion Goal‐directed fluid therapy optimizes the cardiac preload without increasing the ICP in selective neurosurgery ,and it also improves the balance of cerebral oxygen con‐sumption and supply.