3%高渗盐水与 20%甘露醇降低幕上脑肿瘤手术患者颅内压的比较：一项随机、双盲临床试验。
Comparison of 3% Hypertonic Saline and 20% Mannitol for Reducing Intracranial Pressure in Patients Undergoing Supratentorial Brain Tumor Surgery: A Randomized, Double-blind Clinical Trial.
机构信息
Departments of Anesthesiology and Reanimation.
Neurosurgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
出版信息
J Neurosurg Anesthesiol. 2018 Apr;30(2):171-178. doi: 10.1097/ANA.0000000000000446.
BACKGROUND
In the present study, we hypothesized that 3% hypertonic saline (HS) is more effective than 20% mannitol to reduce intracranial pressure (ICP) and to modify brain bulk in patients undergoing an elective supratentorial craniotomy.
MATERIALS AND METHODS
After institutional review board approval, patients scheduled to undergo supratentorial craniotomy were enrolled into this prospective, randomized, double-blind study. The patients were monitored for routine hemodynamic parameters, depth of anesthesia, and ICP. They received 5 mL/kg 20% mannitol (n=20) or 3% HS (n=19) as infusion for 15 minutes. The patients' ICP values were monitored during hypertonic fluid infusion and throughout 30 minutes after infusion as a primary outcome. Secondary outcomes were hemodynamic variables, serum sodium value, blood gases, and surgeon brain relaxation assessment score (1=relaxed, 2=satisfactory, 3=firm, 4=bulging). In addition, the length of intensive care unit and hospital stay were recorded.
RESULTS
Demographic and tumor characteristics were similar between groups. The basal (before hypertonic infusion, ICPT0) and last (30 min after hypertonic infusion finished, ICPT45) ICP values were 13.7±3.0 and 9.5±1.9 mm Hg, respectively, for the M group, which were comparable with the corresponding levels of 14.2±2.8 and 8.7±1.1 mm Hg in the HS group (P>0.05). The median amount of ICP reduction between T0 and T45 timepoints were 4 (1 to 7) and 5 (1 to 9) mm Hg for group M and group HS, respectively (P=0.035). Baseline central venous pressure, pulse pressure variation, and serum sodium and lactate values were similar between groups, but the last measured pulse pressure variation and lactate value were lower, and sodium value was higher in group HS than in group M (P<0.05). Duration of hospital and intensive care unit stay were similar between groups.
CONCLUSIONS
Our results suggest that 3% HS provided more effective ICP reduction than 20% mannitol during supratentorial brain tumor surgery.
背景
在本研究中，我们假设 3%高渗盐水（HS）比 20%甘露醇更有效地降低颅内压（ICP）并改变接受择期幕上开颅手术患者的脑体积。
材料和方法
在机构审查委员会批准后，将计划接受幕上开颅手术的患者纳入这项前瞻性、随机、双盲研究。患者监测常规血流动力学参数、麻醉深度和 ICP。他们接受 5 mL/kg 的 20%甘露醇（n=20）或 3% HS（n=19）静脉输注 15 分钟。作为主要结局，患者的 ICP 值在高渗液输注期间和输注后 30 分钟内进行监测。次要结局为血流动力学变量、血清钠值、血气和外科医生对脑松弛评估评分（1=放松，2=满意，3=坚固，4=隆起）。此外，还记录了重症监护病房和住院时间。
结果
两组患者的人口统计学和肿瘤特征相似。M 组的基础（高渗输注前，ICPTO）和最后（高渗输注结束后 30 分钟，ICPT45）ICP 值分别为 13.7±3.0 和 9.5±1.9 mmHg，与 HS 组相应的 14.2±2.8 和 8.7±1.1 mmHg 相比无差异（P>0.05）。M 组和 HS 组 T0 与 T45 时间点之间 ICP 降低的中位数分别为 4（1 至 7）和 5（1 至 9）mmHg（P=0.035）。两组的基线中心静脉压、脉压变异和血清钠及乳酸值相似，但 HS 组的最后测量的脉压变异和乳酸值较低，钠值较高（P<0.05）。两组的住院和重症监护病房停留时间相似。
结论
我们的结果表明，在幕上脑肿瘤手术中，3%HS 比 20%甘露醇更有效地降低 ICP。
Zotero 插件