急性等容血液稀释对颅内肿瘤患者术中ICP、SvO_2及VBL含量的影响

摘要

目的 观察急性等容血液稀释(ANH)对颅内肿瘤患者术中颅内压(ICP)及颈内静脉血氧饱和度(SvO_2)和乳酸(VBL)含量的影响. 方法 选择择期行幕上颅内肿瘤切除术患者42例,按随机数字表法分为ANH组(n=21)和对照组(n=21).ANH组患者桡动脉放血同时颈内静脉输注等容量羟乙基淀粉,目标血球压积(Hct)=30%.对照组患者不行ANH.2组患者术中均用醋酸林格氏液维持生理需要量.监测2组患者ANH前、ANH后即时、30min、切开硬脑膜前ICP的变化及ANH前、ANH后30 min、1h、术毕动脉氧分压(PaO_2)、颈内静脉血氧分压(PvO_2)、SvO_2、VBL水平. 结果 2组患者各时间点ICP相比差异无统计学意义(P>0.05);ANH后1 h、术毕时对照组患者SvO_2低于ANH组,差异有统计学意义(P<0.05);对照组患者ANH后1 h、术毕与ANH前、ANH后30min相比SvO_2下降,VBL水平升高,差异有统计学意义(P<0.05). 结论 以Hct=30%为稀释目标实施ANH,不增加颅脑手术患者的ICP,有利于脑组织的氧供和对氧的利用.%Objective To investigate the effects of acute normovolemic hemodilution(ANH)on intraoperative intracranial pressure(ICP),jugular venous oxygen saturation(SvO_2),and venous blood lactate(VBL)of patients with intracranial tumor, Methods Forty-two patients,elected to perform supratentorial intracranial tumor resection on some certain days,were randomly divided into ANH(n=21)and control (n=21)groups.Bloodletting was performed in the radial artery after anesthesia induction and the same amount of hydroxyethyl starch was injected into the internal jugular vein at the same time so as to induce the haematocrit reaching to 30% in the ANH group.ANH was not performed in the control group.Acetated Ringer's solution was used during the operation in both groups.The level of arterial partial pressure of oxygen(PaO_2),arterial oxygen saturation(SaO_2),venous oxygen partial pressure (PvO_2),mixed venous O_2 saturation(SvO_2)and VBL was measured before hemodilution(T_0),30 min after the hemodilution(T_1),1 h after the hemodilution(T_2),and at the time the operation was finished(T_3)in both groups.And the changes of ICP before hemodilution(T_0),immediate after hemodilution(T_1),30 min after the hemodilution(T_Ⅱ),and before the endocranium was cut open(T_Ⅲ)in both groups. Results The ICP value in the two groups was not significantly different at different time points;The level of SvO_2 in the control group was significantly lower than that in the ANH group at T_2 and T_3(P<0.05);Significantly decreased level of SvO_2 and increased level of VBL was found in the control group at T2 and T_3 as compared with those in the control group at T_0 and T_Ⅱ(P<0.05). Conclusion Maintaining ICP in patients with intracranial tunlor during the operation through performing ANH with Hct reaching 30%,can significantly improve the oxygen supply and consumption in the brain tissue.