国际麻醉学与复苏杂志   2012, Issue (11): 2-2
    
术中输注高渗氯化钠羟乙基淀粉溶液对脑动脉瘤术后早发性脑血管痉挛的影响
蔡练忠, 陈劲松, 刘友坦, 唐靖, 陈宝东, 史晓勇, 池枫1()
1.深圳大学第一附属医院
Effects of hypertonic sodium chloride hydroxyethyl starch solution on the early cerebral vasospasm after clipping of intracranial aneurysm
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摘要：

【摘要】 目的 探讨术中输注高渗氯化钠羟乙基淀粉溶液（hypertonic sodium chloride hydroxyethyl starch solution， HSH）对脑动脉瘤夹闭术后患者早发性脑血管痉挛（cerebral vasospasm， CVS）的影响。 方法 选择美国麻醉医师协会（ASA）分级Ⅱ~Ⅲ级，Hunt and HessⅡ~Ⅲ级、Glasgow评分13~14分，年龄20岁~60岁拟行脑血管瘤夹闭术的动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage， aSAH）患者20例，按随机数字表法均等分为两组：A组：输注4.2%HSH（实验组）；B组：常规输液（对照组）。A组患者于麻醉诱导前和动脉瘤夹闭后分别静脉输注4.2%HSH40注射液各3 ml/kg，术中液体维持以平衡盐溶液和胶体液按2：1比例输注；B组患者麻醉和手术过程中按2：1比例匀速输注平衡盐溶液和胶体液。记录两组患者输液总量，术中及术后各时点两组患者颅内压（intracerebral pressure, ICP）、平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）、红细胞比容（HCT）及血浆渗透压（plasma osmotic pressure, POP），采用经颅多普勒超声（TCD）监测手术结束时(T5)、术后6 (T6)、12 (T7)、24 h(T8) 两组患者的右侧大脑中动脉血流速度。 结果 A组CVP在T6和T8时点分别显著高于B组（9.4±1.3 vs 7.6±1.0和9.4±1.5 vs 7.2±1.6，P<0.05），而其余血流动力学参数两组间比较差异无统计学意义；A组ICP在T5、T6和T7时点分别低于B组，两组数据比较差异有统计学意义（16.5±4.7 vs 21.5±3.6，20.4±3.2 vs 28.2±3.9和22.6±3.7 vs 27.4±2.7，P<0.05）；A组大脑中动脉血流速度在T6和T7时点分别显著低于于B组（121±15 vs 139±17 和 125±13 vs 137±145，P<0.05）。结论 脑动脉瘤夹闭术中输注4.2% HSH 6 ml/kg可有效减轻术后患者早发性CVS发生程度。
关键词： 高渗氯化钠羟乙基淀粉溶液；脑动脉瘤夹闭术；早发性脑血管痉挛
Abstract:

【Abstract】 Objective To explore the effects of hypertonic sodium chloride hydroxyethyl starch solution(HSH) on the early cerebral vasospasm after clipping of intracranial aneurysm. Methods 20 ASAⅡ-Ⅲ, Hunt and HessⅡ-Ⅲ, Glasgow score 13-14, 20-60-year-old patients undergoing intracranial aneurysm clipping surgery were randomly divided into 2 groups. Group A-HSH infusion group: Patients received 4.2% HSH 6 ml and routine crystalloid-colloid solution intravenously. Group B-Routine solution infusion group. Patients received routine crystalloid-colloid solution intravenously. Total volume of solution infused, intracerebral pressure（ICP）, mean arterial pressure（MAP）, heart rate（HR）， central venous pressure(CVP), hematocrit(HCT) and plasma osmotic pressure(POP) were recorded at different time points during the operation. Right middle cerebral artery blood flow velocity in the two groups was monitored by TCD at the end of operation(T5), 6 h post-operation(T6), 12 h post-operation(T7) and 24 h post-operation(T8), respectively. Results Compared with Group B, CVP in Group A was significantly higher than that in Group B at T6 and T8 (9.4±1.3 vs 7.6±1.0 and 9.4±1.5 vs 7.2±1.6，P<0.05), respectively. ICP in Group A was significantly lower than that in Group B at T5,T6 and T7 (16.5±4.7 vs 21.5±3.6，20.4±3.2 vs 28.2±3.9 and 22.6±3.7 vs 27.4±2.7，P<0.05), respectively. The middle cerebral artery blood velocity in Group A was significantly lower than that in Group B at T6 and T7 (121±15 vs 139±17 and 125±13 vs 137±145，P<0.05), respectively.Conclusion Intravenous infusion of 4.2% HSH 6 ml/kg attenuates the early cerebral vasospasm after clipping of intracranial aneurysm.
Key words: Hypertonic sodium chloride hydroxyethyl starch solution；Clipping of intracranial aneurysm; Early cerebral vasospasm