高渗氯化钠羟乙基淀粉对癫痫手术患者颅内压和血流动力学的影响

目的]评价高渗氯化钠羟乙基淀粉对癫痫手术患者颅内压和血流动力学的影响.方法]40例ASAⅠ～Ⅱ级的癫痫手术病人随机分为高渗氯化钠羟乙基淀粉40组（H组,n=20例）和20%甘露醇组（M组,n=20例）.H组：常规输入林格氏液的同时 ,输入高渗氯化钠羟乙基淀粉40 （4 mL/kg）;M组： 常规输入林格氏液的同时 ,输入20%甘露醇 （4 mL/kg）.监测输注前即刻（T0）、输注后30 min（T1）、60 min（T2）、120 min（T3）及术毕（T4）时的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、颅内压（ICP）,同时检测血红蛋白（Hb）、红细胞比容（Hct）、Na＋和K＋;记录术中输液量、输血量、尿量.结果]组间组内各时点MAP和HR无显著性差异（P〉0.05）;H组T2、T3、T4时CVP较T0时明显升高（P〈0.05）;H组患者ICP在T2、T3、T4时降低,与M组相比差异有显著性（P〈0.05）.H组患者血清Na＋在T2～T4时升高,与M组相比,P〈0.05;两组患者血清K＋在T3、T4时有所降低,但与T0相比无显著性差异（P〉0.05）;两组Hb和Hct在T2～T4时较T0降低（P〈0.05）.H组患者异体用血量和尿量均明显少于M组（P﹤0.05）.结论]高渗氯化钠羟乙基淀粉40能够有效地降低ICP、减少术中用血量并维持血流动力学的稳定,故可安全地用于癫痫患者的手术.

Effect of Hypertonic Sodium Chloride Hydroxyethyl Starch on the Intracranial Pressure and the Hemodynamics in Patients Undergoing Epilepsy Operation

Objective]To investigate the effect of hypertonic sodium chloride hydroxyethyl starch 40 injec tion （HH40）on the intracranial pressure（ICP） and the hemodynamics in patients under epilepsy operation. Methods] Forty patients with ASA Ⅰ～Ⅱ undergoing epilepsy surgery were randomly divided into two groups with 20 cases for each. Group H（ n =20） was infused with Ringer＇s solution and HH40 4mL/kg. Group M was infused Ringer＇s solution and 20% mannitol 4mL/kg. HR, MAP, CVP and ICP before transfusion（T0）, at 30min（T1 ）, 60min（T2 ）, 120min（T3 ） after infusion and the end of operation （T4） were monitored. Hb, Hct, Na＋ and K＋ were measured. The intraoperative transfusion volume, blood transfusion volume and urine volume were recorded. Results]HR and MAP in two groups had no significant difference at all time points （P 〉0.05）. CVP at T2, T3 and T4 in group H was significantly higher than that at To（ P 〈0.05）. ICP at T2, T3 and T4 in group H was significantly lower than that in group M （ P〉0.05）. Serum Na＋ at T2, T3 and T4 in group H increased, and there was significant difference between two groups（ P 〈0.05）. Serum K＋ at T2 , T3 and T4 in two groups decreased, but there was no significant difference between at T2, T3, T4 and at To（ P 〉0.05）. Hb and Hct T2, T3 and T4 in two groups were significantly lower than those at To （ P〈0.05）. The blood transfusion volume and urine volume in group H were significantly less than those in group M（ P 〈0.05）. Conclusion] HH40 can effectively decrease ICP and blood transfusion, and maintain the stable hemodynamics. It can be applied in the surgery of epilepsy patients.