20%甘露醇和3%高渗盐水对开颅手术患者血清电解质的影响

The effect of 20% mannitol and 3% hypertonic saline on the serum electrolytes during craniotomies

目的比较20%甘露醇和3%高渗盐水对开颅手术患者血清电解质的影响。方法选择神经外科择期行开颅手术患者60例,随机分为20%甘露醇组(M组)和3%高渗盐水组(HS组),每组30例。手术过程中,打开硬脑膜前15minM组输注20%甘露醇5ml/kg,HS组输注3%高渗盐水5.35ml/kg。记录高渗液体输注前(T0)、输注完即刻(T,)、输注完15min(T2)、输注完30min(T3)、输注完45min(T4)、输注完60min(T5)、输注完90min(T6),输注完120min(T7)各项观察指标:①血气分析指标:Na^+浓度、Cl^-浓度、K^+浓度、血清pH值等;②平均动脉压(MAP)、心率(HR)、脑松弛度评分(BRS);③数据采集期间输液量、出血量和尿量。结果M组Na^+、Cl^-浓度一过性降低,HS组Na^+、Cl^-浓度一过性增高;与HS组相比,M组K^+浓度一过性升高幅度较大。结论20%甘露醇和3%高渗盐水用于开颅手术过程中都会对机体血清电解质产生影响,且二者影响不同。

Objective To compare the effect of 20% mannitoland 3% hypertonic saline on the serum electrolytes during craniotomy.Methods A total of 60 patients who received elective craniotomy were divided into 20% mannitol group (M group) and 3% hypertonic saline group (HS group), 30 patients in each group.Patients in M group received intravenous infusion of 20% mannitol (5 ml/kg), while patients in HS group received intravenous infusion of 3% hypertonic saline (5.35 nil/kg) for intraoperative brain relaxation before craniotomy.The levels of serum Na^+, Cl^-and K^+ as well serum pH were recorded before (T0) or at 0 min (T1), 15 min (T2), 30 min (T3), 45 min (T4), 60 min (T5), 90 min (T6), and 120 min(T7) after infusion.The amount of intravenous infusion, urine output and bleeding were recorded during the period of data acquisition respectively.Results The levels of serum Na^+, Cl^-in M group decreased temporarily, while the levels of serum Na^+, Cl^-in HS group increased temporarily.Compared with the HS group, the temporary increase of K^+ level in M group was more obvious.Conclusions When 20% mannitol or 3% hypertonic saline is used during craniotomy, the serum electrolytes will be affected, but with different effects.