【摘要】：目的觀察不同劑量3%氯化鈉溶液對(duì)老年神經(jīng)外科手術(shù)患者胸腔液體含量(TFC)和血鈉的影響。方法 120例擬行擇期神經(jīng)外科開顱手術(shù)的老年患者,隨機(jī)均分為3%氯化鈉溶液2ml/kg組(H1組)、3%氯化鈉溶液4ml/kg組(H2組)、3%氯化鈉溶液6ml/kg組(H3組)和甘露醇組(M組)。H組所有患者在麻醉誘導(dǎo)后30min內(nèi)分別給予3%氯化鈉溶液2、4、6ml/kg;M組給予20%甘露醇250ml;其后輸入復(fù)方乳酸鈉5 ml·kg-1·h-1。用無創(chuàng)阻抗儀監(jiān)測入室時(shí)(基礎(chǔ)值,T0)、麻醉誘導(dǎo)后(T1)、切開硬腦膜(T2)和術(shù)畢(T3)時(shí)的MAP、HR、CO、TFC,同時(shí)記錄PaO2、PaCO2、pH、Na+、K+血?dú)夥治?觀察腦膜張力、出血量、尿量、手術(shù)時(shí)間和拔管時(shí)間。結(jié)果與T0時(shí)比較,T1~T3四組患者M(jìn)AP明顯降低(P0.05),T1四組CO明顯降低(P0.05),而T2時(shí)H3組、M組和T3時(shí)H3組CO明顯升高(P0.05),T2時(shí)H3組、M組和T3時(shí)H3組TFC明顯升高(P0.05)。與M組比較,T3時(shí)H3組CO明顯升高(P0.05),T2時(shí)H1組、H2組TFC明顯降低、而H3組TFC明顯升高(P0.05)。與T0時(shí)比較,T1~T3四組PaO2明顯升高(P0.05),T2四組PaCO2明顯降低(P0.05),T3時(shí)H2組和H3組Na+明顯升高(P0.05)。與M組比較,T2時(shí)H3組、T3時(shí)H2組和H3組Na+濃度明顯升高(P0.05)。與H3組比較,H1組、H2組和M組腦張力為良的例數(shù)明顯增加(P0.05)。與M組比較,H1組、H2組、H3組尿量明顯減少(P0.05)。結(jié)論甘露醇和高滲鹽具有很好的穩(wěn)定血流動(dòng)力學(xué)和降低顱內(nèi)壓的作用,但是高滲鹽可顯著增加CO、TFC和Na+濃度,對(duì)老年患者具有增加心肺功能負(fù)擔(dān)的風(fēng)險(xiǎn),應(yīng)該謹(jǐn)慎使用。
[Abstract]:Objective to observe the effects of different doses of 3% sodium chloride solution on the pleural fluid content (TFC) and blood sodium in elderly patients undergoing neurosurgery. Methods 120 elderly patients undergoing elective neurosurgical craniotomy were randomly divided into 3% sodium chloride solution 2ml/kg group (H1 group) and 3% sodium chloride solution 4ml/kg group (H2 group). 3% sodium chloride solution in 6ml/kg group (H3 group) and mannitol group (M group in). H group) all patients were given 3% sodium chloride solution (2ml / kg) in 30min after anesthesia induction. Group M was given 20% mannitol 250 ml, then injected with compound sodium lactate 5 ml kg-1 h-1. The blood gas analysis of PaO2,PaCO2,pH,Na and K were recorded simultaneously by MAP,HR,CO,TFC, after anesthesia induction (T 1), incision of dura mater (T 2) and post operation (T 3) with noninvasive impedance meter. The meningeal tension was observed. Blood loss, urine volume, operation time and extubation time. Results compared with T0, MAP in T1~T3 group was significantly lower (P0.05), CO in T1 group was significantly lower (P0.05), and CO in H3 group, M group and T3 group were significantly higher than those in T0 group (P0.05), H3 group at T2, and H3 group at T2, respectively. TFC in group M and T 3 was significantly higher than that in group H 3 (P 0.05). Compared with M group, the CO of H3 group was significantly higher than that of M group at T3 (P0.05), the TFC of H2 group was significantly lower than that of H1 group at T2 (P0.05), while the TFC of H3 group was significantly higher (P0.05). Compared with T0, PaO2 of T1~T3 group increased significantly (P0.05), PaCO2 of T2 group decreased significantly (P0.05), Na of H2 group and H3 group increased significantly at T3 (P0.05). Compared with M group, Na concentration in T 2 H 3 group, T 3 H 2 group and H 3 group were significantly increased (P 0.05). Compared with H3 group, the cases with good brain tension in H1 group, H2 group and M group were significantly increased (P0.05). Compared with M group, urine volume in H 1 group, H 2 group and H 3 group was significantly decreased (P 0.05). Conclusion mannitol and hypertonic salt can stabilize hemodynamics and decrease intracranial pressure, but hyperosmotic salt can significantly increase the concentration of CO,TFC and Na, and increase the risk of cardiopulmonary function burden in elderly patients.
【作者單位】： 南京醫(yī)科大學(xué)附屬腦科醫(yī)院麻醉科;
【基金】：南京市科技計(jì)劃項(xiàng)目(201201060)
【分類號(hào)】：R614

【共引文獻(xiàn)】

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1 龍瑞芬;許小林;陳益t，

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