每搏量变异指数在甘露醇和高渗盐水防治重度脑梗死患者脑水肿中的应用

Application of Stroke Volume Variation in the Treatment of Cerebral Edema with Mannitol and Hypertonic Saline in Patients with Severe Cerebral Infarction

目的探讨每搏量变异指数(SVV)在甘露醇(M)和高渗盐水(HS)治疗重度脑梗死患者脑水肿中的应用价值。方法回顾性分析90例重度脑梗死合并脑水肿患者的临床资料,根据治疗方式分为20%甘露醇治疗组(M组)和10%高渗盐水组(HS组),每组45例,观察患者输注前(T0)、输注后5 min(T1)、输注后10 min(T2)、输注后30 min(T3)、输注后1 h(T4)、输注后2 h(T5)的平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、心排血指数(CI)和SVV,记录药物起效时间、药物持续时间和用药前后血钠浓度,以及血浆渗透压和尿量。结果 HS组有效降颅压持续时间显著长于M组(P<0.05)。与T0比较,两组患者在T1-T4时点HR、MAP、CVP和CI指标显著升高(P<0.05),而SVV指标显著降低(P<0.05);HS组在T1-T4时点CVP、CI和SVV指标显著高于M组(P<0.05)。治疗后两组患者在血钠浓度和尿量上差异具有统计学意义(P<0.05)。结论与M比较,HS在降低重度脑梗死患者颅内压和持续时间方面更具优势;应用SVV指标能够精确评估两者在降低颅内高压时血管内容量和心排量变化情况。

Objective To investigate the applicability of stroke volume variation（ SVV） to the treatment of cerebral edema with mannitol（ M） and hypertonic saline（ HS） in patients with severe cerebral infarction. Methods The clinical data of 90 patients with severe cerebral infarction complicated with cerebral edema was analyzed retrospectively. The patients were divided into the 20 % mannitol treatment group（ M group） and the 10% hypertonic saline group（ HS group）,45 cases in each group.The mean arterial pressure（ MAP）,central venous pressure（ CVP）,heart rate（ HR）,cardiac index（ CI） and SVV were observed before infusion（ T0）,5 min into infusion（ T1）,10 min after infusion（ T2）,30 min after infusion（ T3）,1 h after infusion（ T4） and 2 h after infusion（ T5）. The onset time and duration of drugs,blood sodium concentrations,plasma osmotic pressure and urine volume before and after treatment were recorded.Results The effective duration of decreasing the intracranial pressure in HS group was significantly longer than that in M group（ P〈0.05）. The HR,MAP,CVP and CI of the two groups at T1-T4 were significantly higher than those at T0,while SVV was lower than at T0（ P〈0.05）. CVP,CI and SVV in HS group at T1-T4 were significantly lower than those in M group（ P〈0.05）. After treatment,there was significant difference between the two groups in blood sodium concentration and urine volume（ P〈0.05）. Conclusion HS has more advantages over M in reducing the intracranial pressure and duration in patients with severe cerebral infarction. The application of SVV can accurately assess the changes of intravascular volume and cardiac output when the two are used reduce intracranial hypertension.