Objective To compare the effects of 7.5% hypertonic saline and 20% mannitol on coagulation during supratentorial tumor resection.Methods A total of 52 patients who were scheduled to receive supratentoraial tumor resection were divided into two groups: a 7.5% hypertonic saline group (HS) and 20% mannitol group (M) (n=26).Patients in each group were infused with 2.5 ml/kg of either 7.5% hypertonic saline or 20% mannitol for intraoperative brain relaxation before craniotomy.The following indexes were recorded before infusion (T0),and 30 min (T1) and 60 min (T2) after infusion: TEG indexes (R,K,α,MA,CI),CCT indexes (PT,APTT,Fib,Hb,Hct) and electrolytes (Na+,K+,Hb,Hct) and fluid intake and outtake volumes.The amounts of intravenous infusion,urinary output and bleeding were recorded.Results Compared with Group M,Group HS showed increases in R,α angle,APTT and the concentration of Na+,but decreases in K,Fib and Hct at T1,as well as increases in α angle and the concentration of Na+ but decreases in K,Fib,Hb and Hct at T2.Conclusions Compared with 20% mannitol,7.5% hypertonic saline produces smaller effects on coagulation during supratentorial tumor resection.%目的 比较7.5%高渗盐水和20%甘露醇用于幕上肿瘤切除术对机体凝血功能的影响.方法 选择神经外科择期行幕上肿瘤手术患者52例,随机分为7.5%高渗盐水组(HS组)和20%甘露醇组(M组),每组26例.手术过程中,打开硬脑膜15 min前HS组开始输注7.5%高渗盐水2.5 ml/kg,M组开始输注20%甘露醇2.5 ml/kg,15~20 min输注完毕.记录输注前即刻(T0)、输注完毕后30 min(T1)、输注完毕后60 min(T2)各项观察指标.①血检弹力图(TEG)指标:反应时间(R)、凝血时间(K)、凝血形成速率(α)、血栓最大幅度(MA)、综合凝血指数(CI);②凝血功能监测(CCT)指标:凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib);③部分血气分析指标:Na+浓度、K+浓度、血红蛋白含量(Hb)、血细胞比容(Hct);④液体出入量等:记录高渗溶液输注完毕后60 min输液量、出血量和尿量.结果 与M组相比,HS组T1时R值、α角、APTT、Na+浓度较高,K值、Fib、Hct较低;T2时α角、Na+浓度较高,K值、Fib、Hb、Hct较低.结论 与20%甘露醇相比,7.5%高渗盐水用于幕上肿瘤切除术对机体凝血功能影响更小.
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