Research and Development Center, Otsuka Pharmaceutical Factory, Inc., Naruto, Tokushima, Japan.
J Neurosurg. 2010 Apr;112(4):824-8. doi: 10.3171/2009.7.JNS09561.
Intraoperative bleeding often obscures the surgical field and may cause neurological damage. The irrigation fluids used during surgery might affect physiological hemostasis because they modulate the extracellular fluid composition of the bleeding area directly. The authors therefore investigated the influence of irrigation fluid on hemostasis in a mouse brain surface bleeding model.
The cerebral cortices of ddY strain mice were exposed under irrigation with normal saline, lactated Ringer (LR) solution, or artificial CSF (ACF-95). To investigate the influence of electrolytes, calcium, potassium, or both were also added to the saline. After 10 minutes of irrigation at 100 ml/hour, sequential photographs of the surgical area were taken with a microscope, and the number of bleeding points was counted visually. Irrigation and counting were performed in a masked manner.
There were significantly more bleeding points after irrigation with normal saline than with ACF-95; LR solution had a similar effect on physiological hemostasis as ACF-95. Saline augmented with calcium or potassium and calcium was superior to normal saline in terms of hemostasis.
The authors demonstrated that the irrigation fluid used in neurosurgery affects bleeding at the surgical site. To avoid surgical site bleeding, ACF-95 and LR solution should be used as irrigation fluids instead of normal saline. The calcium and potassium content of irrigation solutions seems to be important in hemostasis.
术中出血常常会使手术视野模糊，并可能导致神经损伤。手术中使用的灌洗液可能会影响生理止血，因为它们会直接调节出血区域的细胞外液成分。因此，作者在小鼠脑表面出血模型中研究了灌洗液对止血的影响。
在以生理盐水、乳酸林格氏液（LR 溶液）或人工脑脊液（ACF-95）进行灌洗的情况下，暴露 ddY 品系小鼠的大脑皮质。为了研究电解质的影响，还在盐水中添加了钙、钾或两者。以 100ml/h 的速度灌洗 10 分钟后，用显微镜拍摄手术区域的连续照片，并通过肉眼计数出血点的数量。灌洗和计数均以盲法进行。
与 ACF-95 相比，用生理盐水灌洗后出血点明显增多；LR 溶液对生理止血的影响与 ACF-95 相似。添加钙或钾的生理盐水和钙在止血方面均优于生理盐水。
作者证明了神经外科手术中使用的灌洗液会影响手术部位的出血。为了避免手术部位出血，应使用 ACF-95 和 LR 溶液作为灌洗液，而不是生理盐水。灌洗液的钙和钾含量在止血方面似乎很重要。
