3%氯化钠溶液对老年神经外科手术患者胸腔液体含量和血钠的影响
发布时间：2018-12-13 02:59
【摘要】：目的观察不同剂量3%氯化钠溶液对老年神经外科手术患者胸腔液体含量(TFC)和血钠的影响。方法 120例拟行择期神经外科开颅手术的老年患者,随机均分为3%氯化钠溶液2ml/kg组(H1组)、3%氯化钠溶液4ml/kg组(H2组)、3%氯化钠溶液6ml/kg组(H3组)和甘露醇组(M组)。H组所有患者在麻醉诱导后30min内分别给予3%氯化钠溶液2、4、6ml/kg;M组给予20%甘露醇250ml;其后输入复方乳酸钠5 ml·kg-1·h-1。用无创阻抗仪监测入室时(基础值,T0)、麻醉诱导后(T1)、切开硬脑膜(T2)和术毕(T3)时的MAP、HR、CO、TFC,同时记录PaO2、PaCO2、pH、Na+、K+血气分析,观察脑膜张力、出血量、尿量、手术时间和拔管时间。结果与T0时比较,T1~T3四组患者MAP明显降低(P0.05),T1四组CO明显降低(P0.05),而T2时H3组、M组和T3时H3组CO明显升高(P0.05),T2时H3组、M组和T3时H3组TFC明显升高(P0.05)。与M组比较,T3时H3组CO明显升高(P0.05),T2时H1组、H2组TFC明显降低、而H3组TFC明显升高(P0.05)。与T0时比较,T1~T3四组PaO2明显升高(P0.05),T2四组PaCO2明显降低(P0.05),T3时H2组和H3组Na+明显升高(P0.05)。与M组比较,T2时H3组、T3时H2组和H3组Na+浓度明显升高(P0.05)。与H3组比较,H1组、H2组和M组脑张力为良的例数明显增加(P0.05)。与M组比较,H1组、H2组、H3组尿量明显减少(P0.05)。结论甘露醇和高渗盐具有很好的稳定血流动力学和降低颅内压的作用,但是高渗盐可显著增加CO、TFC和Na+浓度,对老年患者具有增加心肺功能负担的风险,应该谨慎使用。
[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.
【作者单位】： 南京医科大学附属脑科医院麻醉科;
【基金】：南京市科技计划项目(201201060)
【分类号】：R614
[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.
【作者单位】： 南京医科大学附属脑科医院麻醉科;
【基金】：南京市科技计划项目(201201060)
【分类号】：R614
【共引文献】
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