PiCCO监测不同剂量甘露醇对颅脑损伤患者心肺功能及脱水的影响

Cardiopulmonary and dehydrated effects of different doses of mannitol on the craniocerebral trauma patients by PiCCO monitoring

目的:通过单指示剂跨肺热稀释技术(Pi CCO)监测,探讨不同剂量甘露醇对颅脑损伤患者心肺功能及脱水作用的影响。方法:选取颅脑损伤患者20例,行Pi CCO监测。患者随机分为两组,给予20%甘露醇Ⅰ组125 ml、Ⅱ组250 ml。测量给甘露醇之前(T0)及给甘露醇后30 min(T1)、1 h(T2)、2 h(T3)、3 h(T4)时患者的各项生命体征及Pi CCO数值。结果:Ⅱ组组内各时间点与T0比较,全身血管阻力指数(SVRI)在T1时显著低于T0(P<0.05),全心射血分数、心功能指数在T1时显著高于T0(P<0.05)。两组尿量比较,在T2及T3时Ⅱ组显著高于Ⅰ组(P<0.05)。Pi CCO值比较,SVRI在T2及T4时Ⅱ组显著高于Ⅰ组(P<0.05),左室收缩力指数在T0、T2、T3及T4时Ⅱ组低于Ⅰ组(P<0.05)。结论:大剂量甘露醇可以显著增加心脏做功;大剂量甘露醇利尿作用强于小剂量甘露醇;对原有基础心脏疾病的颅脑损伤患者,使用小剂量甘露醇安全性更高。

Objective： To investigate the effects of different mannitol dosages on the patients with brain injuries by Pi CCO monitoring. Methods： Twenty patients with brain injuries were monitored by Pi CCO. The patients were randomly divided into two groups and infused 20% mannitol 125 ml（ group Ⅰ,n = 10） or 250 ml（ group Ⅱ,n =10）. Patients＇ vital signs and Pi CCO values were measured before the medication（ T0） and after the medication 30minutes（ T1）,1 h（ T2）,2 h（ T3） and 3 h（ T4）. Results： In group Ⅱ,as compared with T0,SVRI was significantly decreased（ P〈0. 05）,GEF and CFI were significantly increased（ P〈0. 05） at T1. As compared with groupⅠ,urine volume was significantly increased at T2 and T3（ P〈0. 05）,SVRI was significantly increased at the T2 and T4（ P〈0. 05） and d Pmx was significantly decreased at the T0,T2,T3,T4（ P〈0. 05） in group Ⅱ.Conclusion： Large dose mannitol significantly increases cardiac work. Compared with small dose mannitol,large dose is stronger diuresis effection. Small dose mannitol has higher security than large dose for craniocerebral trauma patients who suffered from heart disease.