Hirasawa K, Kasuya H, Hori T
Department of Neurosurgery, Tokyo Women's Medical University, Japan.
J Neurosurg. 2000 Oct;93(4):581-5. doi: 10.3171/jns.2000.93.4.0581.
The importance of monitoring circulating blood volume (CBV) during perioperative management is widely recognized in critically ill patients. The purpose of this study was to investigate the change in CBV following craniotomy by using indocyanine-green pulse spectrophotometry.
Circulating blood volume and plasma hormones related to stress and fluid regulation were measured five times: preoperatively, immediately postoperatively, and 1, 2, and 7 days after craniotomy was performed in 17 patients with a brain tumor or an unruptured aneurysm. The mean value of CBV preoperatively was 82 ml/kg, which decreased to 64 ml/kg (78%) immediately postoperatively and gradually recovered to 82 ml/kg on Day 7 postsurgery (p = 0.0069). The mean values of adrenaline, noradrenaline, arginine vasopressin, renin, and aldosterone were highest immediately postoperatively. The mean intraoperative balances of water and sodium were 1,090 ml and 113 mEq, respectively. Partial correlation coefficients of CBV to noradrenaline and serum sodium during the entire study were -0.430 (p = 0.0036) and 0.418 (p = 0.0048), respectively.
Attention should be paid to decreased CBV following craniotomy, which is caused by the shift of fluid to interstitial spaces due to surgical stress. Hypovolemia can be suspected from a postoperative decrease in serum sodium.
在重症患者围手术期管理中，监测循环血容量（CBV）的重要性已得到广泛认可。本研究的目的是使用吲哚菁绿脉搏分光光度法研究开颅术后CBV的变化。
对17例脑肿瘤或未破裂动脉瘤患者在术前、术后即刻以及开颅术后1、2和7天测量循环血容量和与应激及液体调节相关的血浆激素。术前CBV的平均值为82 ml/kg，术后即刻降至64 ml/kg（78%），术后第7天逐渐恢复至82 ml/kg（p = 0.0069）。肾上腺素、去甲肾上腺素、精氨酸加压素、肾素和醛固酮的平均值在术后即刻最高。术中水和钠的平均平衡量分别为1090 ml和113 mEq。在整个研究期间，CBV与去甲肾上腺素和血清钠的偏相关系数分别为-0.430（p = 0.0036）和0.418（p = 0.0048）。
应注意开颅术后CBV的降低，这是由手术应激导致液体转移至间质间隙所致。术后血清钠降低可怀疑存在血容量不足。
