3%氯化钠溶液对老年神经外科手术患者胸腔液体含量和血钠的影响

Effect of hypertonic saline on thoracic fluid content and plasma natrium in aged neurosurgical patients

目的观察不同剂量3%氯化钠溶液对老年神经外科手术患者胸腔液体含量（TFC）和血钠的影响。方法 120例拟行择期神经外科开颅手术的老年患者,随机均分为3%氯化钠溶液2ml/kg组（H1组）、3%氯化钠溶液4ml/kg组（H2组）、3%氯化钠溶液6ml/kg组（H3组）和甘露醇组（M组）。H组所有患者在麻醉诱导后30min内分别给予3%氯化钠溶液2、4、6ml/kg;M组给予20%甘露醇250ml;其后输入复方乳酸钠5 ml·kg^-1·h^-1。用无创阻抗仪监测入室时（基础值,T0）、麻醉诱导后（T1）、切开硬脑膜（T2）和术毕（T3）时的MAP、HR、CO、TFC,同时记录PaO2、PaCO2、pH、Na^＋、K^＋血气分析,观察脑膜张力、出血量、尿量、手术时间和拔管时间。结果与T0时比较,T1-T3四组患者MAP明显降低（P〈0.05）,T1四组CO明显降低（P〈0.05）,而T2时H3组、M组和T3时H3组CO明显升高（P〈0.05）,T2时H3组、M组和T3时H3组TFC明显升高（P〈0.05）。与M组比较,T3时H3组CO明显升高（P〈0.05）,T2时H1组、H2组TFC明显降低、而H3组TFC明显升高（P〈0.05）。与T0时比较,T1-T3四组PaO2明显升高（P〈0.05）,T2四组PaCO2明显降低（P〈0.05）,T3时H2组和H3组Na^＋明显升高（P〈0.05）。与M组比较,T2时H3组、T3时H2组和H3组Na^＋浓度明显升高（P〈0.05）。与H3组比较,H1组、H2组和M组脑张力为良的例数明显增加（P〈0.05）。与M组比较,H1组、H2组、H3组尿量明显减少（P〈0.05）。结论甘露醇和高渗盐具有很好的稳定血流动力学和降低颅内压的作用,但是高渗盐可显著增加CO、TFC和Na＋浓度,对老年患者具有增加心肺功能负担的风险,应该谨慎使用。

Objective This study was to investigate the effect of hypertonic saline on thoracic fluid content and plasma natrium in aged neurosurgical patients.Methods One hundred and twenty aged patients undergoing neurosurgery were randomly divided into hypertonic saline group or mannitol group.Patients in the hypertonic saline group received 3% NaCl 250 ml infusion after anesthesia induction within 30 minutes,while patients in other group received 20% mannitol 2,4,or 6 ml/kg.The mean artery pressure,heart rate,ICG-cardiac output,thoracic fluid content,and arterial blood gas analysis were monitored.The surgeons＇ assessment on cerebral dura mater tension,bleeding volume,urine output,surgical time and extubation time were also recorded.Results Compared with the baseline,the MAP and CO were decreased after anesthesia induction in all groups,and were recovered later with more significance in hypertonic saline group.There was no difference in HR in all groups.The CO and TFC were increased in both hypertonic saline and mannitol group,and were back to normal in the mannitol group（P〈0.05）.Hypertonic saline and mannitol had a better effect on lower the cerebral dura matter tension.However hypertonic saline may cause a increase of plasma natrium（P〈0.05）.Conclusion Both hypertonic saline and mannitol have beneficial effect on hemodynamics and intra-cranial pressure.However,hypertonic saline may increase TFC and natrium,which may bring an additional burden to the cardiac and respiratory function in aged patients.