Kasuya Hidetoshi, Onda Hideaki, Yoneyama Taku, Sasaki Toshiyuki, Hori Tomokatsu
Department of Neurosurgery, Tokyo Women's Medical University, Japan.
Stroke. 2003 Apr;34(4):956-60. doi: 10.1161/01.STR.0000064321.10700.63. Epub 2003 Mar 20.
Maintenance of an adequate intravascular volume is important in the management of patients with subarachnoid hemorrhage (SAH). The purpose of this study was to investigate the circulating blood volume (CBV) after SAH with the use of indocyanine green pulse spectrophotometry.
CBV and plasma hormones related to stress and fluid regulation were measured 4 times: day 2 to 3, day 4 to 5, day 7 to 8, and day 14 in 50 consecutive patients with SAH surgically treated within 48 hours.
The mean value of CBV was 64 mL/kg on day 2 to 3, which gradually increased to 69 mL/kg on day 4 to 5, 71 mL/kg on day 7 to 8, and 70 mL/kg on day 14 (P=0.005) (control, 72 mL/kg). The clinical grades and plasma corticotropin levels were higher in patients with <60 mL/kg of CBV on day 2 to 3 (P<0.05 for both). There were no significant differences in other physiological and laboratory parameters such as time for surgery, estimated blood loss, levels of plasma noradrenaline, brain natriuretic peptide, serum sodium, and hematocrit. When CBV was decreased >10% of the former level, there were decreases in hematocrit (P<0.05), serum sodium (P<0.01), and serum albumin (P<0.05) and an increase in urinary sodium (P<0.05).
A significant reduction of CBV, especially in patients with poor clinical grades, was noted after SAH and early surgery, which could not be detected by routine examinations. Anemia, central salt wasting, and hypoalbuminemia may be related to a decrease in CBV from the former level. Indocyanine green pulse spectrophotometry may be a powerful tool for the management of patients with SAH.
维持充足的血管内容量在蛛网膜下腔出血（SAH）患者的管理中至关重要。本研究的目的是使用吲哚菁绿脉搏分光光度法研究SAH后的循环血容量（CBV）。
对48小时内接受手术治疗的50例连续SAH患者在第2至3天、第4至5天、第7至8天和第14天进行了4次CBV和与应激及液体调节相关的血浆激素测量。
第2至3天CBV的平均值为64 mL/kg，在第4至5天逐渐增加至69 mL/kg，第7至8天为71 mL/kg，第14天为70 mL/kg（P = 0.005）（对照组为72 mL/kg）。第2至3天CBV<60 mL/kg的患者临床分级和血浆促肾上腺皮质激素水平较高（两者均P<0.05）。手术时间、估计失血量、血浆去甲肾上腺素水平、脑钠肽、血清钠和血细胞比容等其他生理和实验室参数无显著差异。当CBV较前一水平降低>10%时，血细胞比容（P<0.05）、血清钠（P<0.01）和血清白蛋白（P<0.05）降低，尿钠增加（P<0.05）。
SAH和早期手术后观察到CBV显著降低，尤其是临床分级较差的患者，这是常规检查无法检测到的。贫血、中枢性盐耗竭和低白蛋白血症可能与CBV较前一水平降低有关。吲哚菁绿脉搏分光光度法可能是管理SAH患者的有力工具。
